Healthcare Provider Details

I. General information

NPI: 1780898668
Provider Name (Legal Business Name): JENNIFFER ANN MANAVI M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 N HESPERIAN ST
SANTA ANA CA
92706-1151
US

IV. Provider business mailing address

411 IRVINE AVE
NEWPORT BEACH CA
92663-5119
US

V. Phone/Fax

Practice location:
  • Phone: 714-836-2700
  • Fax: 714-836-2701
Mailing address:
  • Phone: 949-574-1645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: