Healthcare Provider Details

I. General information

NPI: 1316381940
Provider Name (Legal Business Name): LISA KAY MANZANARES D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA BARNARD

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 S ORANGE AVE
FRESNO CA
93702-3463
US

IV. Provider business mailing address

PO BOX 1559
BAKERSFIELD CA
93302-1559
US

V. Phone/Fax

Practice location:
  • Phone: 559-457-5400
  • Fax: 559-457-5490
Mailing address:
  • Phone: 661-635-3050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number20A13946
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A13946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: