Mari Carlo Manzana, M.D., Inc.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

MARI CARLO MANZANA, M.D., INC.

Practice address

2410 Commerce TRL
Imperial, CA 92251-4003

Phone

(661) 714-1560

NPI assigned

Aug 26, 2020

Last updated

Sep 5, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mari Carlo Manzana, MDNPI 1063946341

Title

Ceo

Phone

(661) 714-1560

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mari Carlo Manzana

  • Family Medicine Physician
  • Indio, CA
  • NPI 1063946341
  NPD Authorized official

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

{
    "created_epoch": "1598400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599264000000",
    "number": "1336752526",
    "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",
            "fax_number": "847-221-6838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2410 COMMERCE TRL",
            "city": "IMPERIAL",
            "state": "CA",
            "postal_code": "922514003",
            "telephone_number": "661-714-1560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARI CARLO MANZANA, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-26",
        "last_updated": "2020-09-05",
        "certification_date": "2020-09-05",
        "status": "A",
        "authorized_official_last_name": "MANZANA",
        "authorized_official_first_name": "MARI CARLO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "661-714-1560",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ray Mun Loo, M.D
• Lizbeth Lopez
• Danielle Madrigal
• Raul Alex Mancilla, O.D.
• Manzana Family Medicine LLC
• Stacie Ann Martin, APRN
• Tyler Sanga Martin, NP
• Carlos Martinez Calderon, DDS
• Elyssa Marie Martinez, ASSOCIATE'S DEGREE
• Kameron Martinez

• Clinic/Center in Imperial, CA
• Providers in Imperial, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2020; 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.