Individual provider Active NPI

Maria Esperanza Manzo

  • Family Nurse Practitioner
  • West Covina, CA
National Provider Identifier
1336521400
Registry record updated Jun 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
NP95002532 Issued in CA
Practice address
420 S Glendora Ave
West Covina, CA 91790-3001
Phone
(626) 919-4333
NPI assigned
Jun 24, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NP95002532 CA Primary

Addresses

Primary practice location

420 S Glendora Ave
West Covina, CA 91790-3001

Mailing address

420 S Glendora Ave
West Covina, CA 91790-3001
Phone (626) 919-4333

Other names 1

  • Maria Esperanza Manzo-Avina Professional name

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151026002486 CA Practitioner - Nurse Practitioner 4880903269 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP95002532CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
East Valley Community Health Center, Inc. Current Accepting new patients
East Valley Community Health Center, Inc. CurrentSince Oct 26, 2015 Accepting new patients
East Valley Community Health Center, Inc. CurrentSince Oct 26, 2015 Accepting new patients

Locations

1555 S Garey Ave
Pomona, CA 91766
Phone (909) 620-8088

420 S Glendora Ave
West Covina, CA 91790
Phone (626) 919-5724

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: mmanzohernandez323270@direct.ochin.org

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1435104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466726400000",
    "number": "1336521400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 S GLENDORA AVE",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917903001",
            "telephone_number": "626-919-4333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 S GLENDORA AVE",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917903001",
            "telephone_number": "626-919-4333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANZO",
        "first_name": "MARIA",
        "middle_name": "ESPERANZA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-24",
        "last_updated": "2016-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP95002532",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIA",
            "last_name": "MANZO-AVINA",
            "middle_name": "ESPERANZA",
            "credential": "NP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in West Covina, CA

Sources for this page

Verify at the official NPI Registry.