Healthcare Provider Details

I. General information

NPI: 1689147589
Provider Name (Legal Business Name): MALAYA MANACOP ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 POLK ST FL 4
SAN FRANCISCO CA
94109-7813
US

IV. Provider business mailing address

1714 FRANKLIN ST # 100-263
OAKLAND CA
94612-3488
US

V. Phone/Fax

Practice location:
  • Phone: 415-292-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number126227
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number102284
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: