Mari Carlo Manzana

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A157573 Issued in CA

Practice address

46900 Monroe St
Indio, CA 92201-4827

Phone

(833) 574-2273

NPI assigned

Apr 13, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of California, San Diego School of Medicine, 2017

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Riverside, CA
  • NPI 1316979834
  Medicare reassignment NPD
• Manzana Family Medicine LLC

  • Clinic/Center
  • Imperial, CA
  • NPI 1093325375
  NPD Authorized official
• Mari Carlo Manzana, M.D., Inc.

  • Clinic/Center
  • Imperial, CA
  • NPI 1336752526

  Family Medicine

  NPD Authorized official

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

{
    "created_epoch": "1492041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638489600000",
    "number": "1063946341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 66",
            "city": "IMPERIAL",
            "state": "CA",
            "postal_code": "922510066",
            "telephone_number": "760-332-8688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46900 MONROE ST",
            "city": "INDIO",
            "state": "CA",
            "postal_code": "922014827",
            "telephone_number": "833-574-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANZANA",
        "first_name": "MARI CARLO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-13",
        "last_updated": "2021-12-03",
        "certification_date": "2020-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A157573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10800 Magnolia Ave",
            "city": "Riverside",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925053043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Freeman Mambo
• Lorie Jean Mangen, ASW
• Sarah Manalansan Manneh, M.D.
• Carol Jane Manners
• Yolanda Vargas Manney
• Stephanie Marak
• Nydia Ellena Maravilla, RADT
• Marie Marcinko, RN
• Ronald Marcus
• John Mardones, M.D.

• Family Medicine Physician in Indio, CA
• Providers in Indio, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.