Healthcare Provider Details

I. General information

NPI: 1326154428
Provider Name (Legal Business Name): JAMES ROBERT MANNES PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 E COLORADO BLVD #200
PASADENA CA
91106
US

IV. Provider business mailing address

911 E COLORADO BLVD #200
PASADENA CA
91106
US

V. Phone/Fax

Practice location:
  • Phone: 626-755-0073
  • Fax: 805-525-1764
Mailing address:
  • Phone: 626-755-0073
  • Fax: 805-525-1764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License NumberM16986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: