Healthcare Provider Details

I. General information

NPI: 1629885934
Provider Name (Legal Business Name): MARTHA MANZO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E 13TH ST
MERCED CA
95341-6211
US

IV. Provider business mailing address

4181 ADOBE CT
MERCED CA
95348-7005
US

V. Phone/Fax

Practice location:
  • Phone: 209-381-6800
  • Fax:
Mailing address:
  • Phone: 209-658-7234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1543210124
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: