Healthcare Provider Details

I. General information

NPI: 1326500414
Provider Name (Legal Business Name): CRYSTAL MANZO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 W SHAW AVE STE 107
FRESNO CA
93711-3303
US

IV. Provider business mailing address

3433 W SHAW AVE STE 102
FRESNO CA
93711-3229
US

V. Phone/Fax

Practice location:
  • Phone: 559-558-4051
  • Fax:
Mailing address:
  • Phone: 559-374-3990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW133240
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW107720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: