Healthcare Provider Details

I. General information

NPI: 1063980928
Provider Name (Legal Business Name): MANISHA ATI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44151 15TH ST W STE 101
LANCASTER CA
93534-4079
US

IV. Provider business mailing address

PO BOX 512185
LOS ANGELES CA
90051-0185
US

V. Phone/Fax

Practice location:
  • Phone: 661-902-5600
  • Fax: 661-951-0686
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009916
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: