Healthcare Provider Details

I. General information

NPI: 1093962185
Provider Name (Legal Business Name): MANUEL ANDRES MANOTAS PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 SUTTER ST SUITE 206
SAN FRANCISCO CA
94109-6023
US

IV. Provider business mailing address

6 SNOWDEN LN
FAIRFAX CA
94930-1029
US

V. Phone/Fax

Practice location:
  • Phone: 415-891-9562
  • Fax:
Mailing address:
  • Phone: 786-487-5079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY26343
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: