Individual
ELLEN E. MANZULLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4009
(713) 792-6161
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
H1984
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100422801
—
TX
01
—
110133057
RR MEDICARE
TX
01
—
800368
BCBS
TX
Enumeration date
09/13/2006
Last updated
07/05/2012
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