Healthcare Provider Details

I. General information

NPI: 1245841022
Provider Name (Legal Business Name): CRISTY ALEXANDRA GAMEZ MANZANARES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date: 08/11/2026
Reactivation Date: 08/24/2026

III. Provider practice location address

150 GRAND AVE STE 200
OAKLAND CA
94612-3726
US

IV. Provider business mailing address

150 GRAND AVE STE 200
OAKLAND CA
94612-3726
US

V. Phone/Fax

Practice location:
  • Phone: 510-923-1099
  • Fax: 510-923-0894
Mailing address:
  • Phone: 510-923-1099
  • Fax: 510-923-0894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number129929
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: