Andy Raul Manzano Matos, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

1551 Issued in PR

Practice address

11329 West Ave
San Antonio, TX 78213-1341

Phone

(210) 886-8666

Fax

(210) 886-8667

NPI assigned

Mar 27, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Practical Health Management LLC

  • Family Medicine Physician
  • San Antonio, TX
  • NPI 1710606249
  NPD
• JM Research, PLLC

  • Primary Care Clinic/Center
  • Houston, TX
  • NPI 1972931020
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1679875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682380800000",
    "number": "1043913163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11329 WEST AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782131341",
            "telephone_number": "210-886-8666",
            "fax_number": "210-886-8667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11329 WEST AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782131341",
            "telephone_number": "210-886-8666",
            "fax_number": "210-886-8667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANZANO MATOS",
        "first_name": "ANDY",
        "middle_name": "RAUL",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-03-27",
        "last_updated": "2023-04-25",
        "certification_date": "2023-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PR",
            "license": "1551",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Manuppelli, PHD LMFT LPC
• Tatum Manz
• Manza Diagnostic Ultrasound
• Ornella Gissel Manzaba
• Maria Manzanilla, RN
• Taylor Michelle Manzella, DO
• Christopher Andy Mao
• Maple Hospice LLC
• Bianca Maples, RD
• Johnae Marie Mapp

• Medical Physician Assistant in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Medical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.