Healthcare Provider Details

I. General information

NPI: 1295286698
Provider Name (Legal Business Name): MANAS KSHIRSAGAR AD MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2541 SOQUEL AVE
SANTA CRUZ CA
95062-1404
US

IV. Provider business mailing address

2541 SOQUEL AVE
SANTA CRUZ CA
95062-1404
US

V. Phone/Fax

Practice location:
  • Phone: 831-462-3776
  • Fax: 831-462-3706
Mailing address:
  • Phone: 831-462-3776
  • Fax: 831-462-3706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: