Healthcare Provider Details

I. General information

NPI: 1619882107
Provider Name (Legal Business Name): MANMAYA TAMANG LVN DISPENSING NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MARKET ST FL 1
SAN FRANCISCO CA
94103-1589
US

IV. Provider business mailing address

1111 MARKET ST FL 1
SAN FRANCISCO CA
94103-1589
US

V. Phone/Fax

Practice location:
  • Phone: 415-862-2810
  • Fax: 415-863-7343
Mailing address:
  • Phone: 415-862-2810
  • Fax: 415-863-7343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number758494
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: