MEDICARE: MRS. KRYSTINA MAE MANIU MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	8700	CA

General Provider Information

NPI Number	:	1336679760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRYSTINA MAE MANIU MS

Provider Business Mailing Address
First Line	:	34272 HIDDEN COVE DR
Second Line	:
City	:	YUCAIPA
State	:	CA
Zip	:	92399-2595
Country	:	US
Telephone Number	:	909-936-2424
Fax Number	:

Provider Business Practice Location Address
First Line	:	77564 COUNTRY CLUB DR # A201
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-0484
Country	:	US
Telephone Number	:	760-702-0095
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2017
Last Update Date	:	06/19/2026

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