Healthcare Provider Details

I. General information

NPI: 1972128767
Provider Name (Legal Business Name): ANNETTE P MANZO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

298 BERNAL RD
SAN JOSE CA
95119-1809
US

IV. Provider business mailing address

298 BERNAL RD
SAN JOSE CA
95119-1809
US

V. Phone/Fax

Practice location:
  • Phone: 408-780-0755
  • Fax:
Mailing address:
  • Phone: 408-780-0755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License NumberR1478420220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: