Healthcare Provider Details

I. General information

NPI: 1619023769
Provider Name (Legal Business Name): JEFFREY D MANESE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 11/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CASTRO ST SUITE 432
SAN FRANCISCO CA
94114-1010
US

IV. Provider business mailing address

4333 FLEMING AVE
OAKLAND CA
94619-2529
US

V. Phone/Fax

Practice location:
  • Phone: 415-865-3737
  • Fax:
Mailing address:
  • Phone: 510-261-5962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 18366
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT20351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: