Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Manzanita Medical PLLC

Organization Family Medicine Physician · NPI 1306376611

Manzanita Medical PLLC is a Family Medicine Physician in Phoenix, Arizona. Licensed in Arizona. Registered with an NPI since 2017.

Licensed in
AZ
In the registry since
2017
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4545 E Shea Blvd Ste 130
Phoenix, AZ 85028-3061
Phone: (480) 292-9532
Fax: (480) 664-3482
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X (AZ)

Record details

NPI number1306376611
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Judith Hallas — Office Manager · (480) 292-9532
NPI enumeratedJune 19, 2017
Last updated in NPPESJuly 23, 2024
Certification dateMay 8, 2023
Mailing address4545 E Shea Blvd Ste 130, Phoenix, AZ 85028-3061

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