Healthcare Provider Details

I. General information

NPI: 1053092668
Provider Name (Legal Business Name): VISHVA MANIAR MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 FOLSOM ST STE 702
SAN FRANCISCO CA
94107-4502
US

IV. Provider business mailing address

2530 BALBOA ST APT 4
SAN FRANCISCO CA
94121-2931
US

V. Phone/Fax

Practice location:
  • Phone: 415-715-1050
  • Fax:
Mailing address:
  • Phone: 219-670-3538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: