Provider Demographics
NPI:1366773897
Name:MANZANILLA, GLORIA VICTORIA (NP)
Entity type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:VICTORIA
Last Name:MANZANILLA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:1 GUSTAVE L LEVY PL # 1030
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6500
Mailing Address - Country:US
Mailing Address - Phone:212-241-0905
Mailing Address - Fax:212-241-0065
Practice Address - Street 1:1 GUSTAVE L LEVY PL # 1030
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6500
Practice Address - Country:US
Practice Address - Phone:212-241-0905
Practice Address - Fax:212-241-0065
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF430219-0363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care