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NPI Code Detail

MEDICARE: DR. AVON DAY MANNEY

MEDICARE: DR. AVON DAY MANNEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1204C00000XSports Medicine (Neuromusculoskeletal Medicine) Physician20A11349CA
2204D00000XNeuromusculoskeletal Medicine & OMM Physician20A11349CA
3208100000XPhysical Medicine & Rehabilitation Physician20A11349CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
120A11349OTHERCACALIFORNIA LICENSE NUMBER

General Provider Information

NPI Number : 1689980534
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AVON DAY MANNEY
Provider Business Mailing Address
First Line : PO BOX 2097
Second Line :
City : DUBLIN
State : CA
Zip : 94568-0209
Country : US
Telephone Number : 510-859-4196
Fax Number :
Provider Business Practice Location Address
First Line : 5737 THORNHILL DR STE 207B
Second Line :
City : OAKLAND
State : CA
Zip : 94611-2144
Country : US
Telephone Number : 510-859-4196
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2010
Last Update Date : 09/14/2018

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