Healthcare Provider Details

I. General information

NPI: 1831039445
Provider Name (Legal Business Name): NIPA MANFREDI PANYARIT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 S MISSION RD
FALLBROOK CA
92028-3202
US

IV. Provider business mailing address

945 S MISSION RD
FALLBROOK CA
92028-3202
US

V. Phone/Fax

Practice location:
  • Phone: 760-723-9512
  • Fax:
Mailing address:
  • Phone: 760-723-9512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number83922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: