MEDICARE: DR. MICHAEL RICHARD MANUEL M.D.

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
1	207VX0201X	Gynecologic Oncology Physician	A68842	CA
2	207VX0201X	Gynecologic Oncology Physician	25MA08946800	NJ

General Provider Information

NPI Number	:	1780630095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL RICHARD MANUEL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 54679
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90054-0679
Country	:	US
Telephone Number	:	310-967-1780
Fax Number	:	310-967-1773

Provider Business Practice Location Address
First Line	:	1513 S GRAND AVE
Second Line	:	SUITE 400
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3070
Country	:	US
Telephone Number	:	213-742-6400
Fax Number	:	213-742-6089

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	01/06/2020

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