Healthcare Provider Details

I. General information

NPI: 1003811977
Provider Name (Legal Business Name): MANOS BANBURY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6061 BANBURY ST
SAN DIEGO CA
92139-3624
US

IV. Provider business mailing address

6061 BANBURY ST
SAN DIEGO CA
92139-3624
US

V. Phone/Fax

Practice location:
  • Phone: 619-475-2211
  • Fax: 619-479-5326
Mailing address:
  • Phone: 619-475-2211
  • Fax: 619-479-5326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: PAMELA J CADDELL
Title or Position: ADMINISTRATIVE MANAGER
Credential:
Phone: 619-475-2211