| Doctor Name: | MR. FIDEL MANZANO CADAG |
| NPI Number: | 1023434016 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP - C |
| License Number: | 23558 |
| Business Practice Address: | 1850 Sullivan Ave Suite 310 Daly City, CA - 940152221 |
| Business Phone Number: | 6507553939 |
| Business Fax Number: | 6507553883 |
| Mailing Address: | 1850 Sullivan Ave, Suite 310 DALY CITY |
| State: | CA |
| Postal Code: | 940152221 |
| Phone Number: | 6507553939 |
| Fax Number: | 6507553883 |
| NPI Enumeration Date: | 03/14/2014 |
| NPI Last Update Date: | 03/14/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 23558 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |