Healthcare Provider Details

I. General information

NPI: 1215847439
Provider Name (Legal Business Name): MANETTA PSYCHOLOGY APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5560 LA JOLLA BLVD STE B
LA JOLLA CA
92037-7650
US

IV. Provider business mailing address

5560 LA JOLLA BLVD STE B
LA JOLLA CA
92037-7650
US

V. Phone/Fax

Practice location:
  • Phone: 619-393-1447
  • Fax: 619-393-1410
Mailing address:
  • Phone: 619-393-1447
  • Fax: 619-393-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ETIANNE MANETTA
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 619-393-1447