Healthcare Provider Details

I. General information

NPI: 1205557089
Provider Name (Legal Business Name): ABDUL MANAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 GEARY ST
SAN FRANCISCO CA
94109-7228
US

IV. Provider business mailing address

3484 HILLSBOROUGH DR
CONCORD CA
94520-1559
US

V. Phone/Fax

Practice location:
  • Phone: 628-216-0303
  • Fax:
Mailing address:
  • Phone: 603-943-9179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License NumberY8844044
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: