Healthcare Provider Details

I. General information

NPI: 1164524088
Provider Name (Legal Business Name): MANISHA S. KUMAR D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 06/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 VALLEY CENTRE DR
SAN DIEGO CA
92130-3318
US

IV. Provider business mailing address

54433 FILE
LOS ANGELES CA
90074-0001
US

V. Phone/Fax

Practice location:
  • Phone: 858-764-3465
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number20A7919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: