Healthcare Provider Details

I. General information

NPI: 1427930163
Provider Name (Legal Business Name): MANABU KANEKO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 VIEWRIDGE AVE
SAN DIEGO CA
92123-1638
US

IV. Provider business mailing address

4660 VIEWRIDGE AVE
SAN DIEGO CA
92123-1638
US

V. Phone/Fax

Practice location:
  • Phone: 760-227-1354
  • Fax:
Mailing address:
  • Phone: 760-227-1354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20066
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number745590
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: