# MANZANITA MEDICAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306376611
- **Authorized official:** JUDITH HALLAS (OFFICE MANAGER)
- **Authorized official phone:** (480) 292-9532

## Contact information

- **Practice address:** 4545 E SHEA BLVD STE 130, PHOENIX, AZ 85028-3061
- **Practice address phone:** (480) 292-9532
- **Practice address fax:** (480) 664-3482
- **Mailing address:** 4545 E SHEA BLVD STE 130, PHOENIX, AZ 85028-3061
- **Mailing address phone:** (480) 292-9532
- **Mailing address fax:** (480) 664-3482

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | AZ | Yes |

## Other

- **Enumeration date:** 06/19/2017
- **Last updated:** 07/23/2024