Healthcare Provider Details

I. General information

NPI: 1316422827
Provider Name (Legal Business Name): YENIFER YESICA MANZO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1668 CALLENS RD STE J
VENTURA CA
93003-8395
US

IV. Provider business mailing address

331 N DRISKILL ST
OXNARD CA
93030-5520
US

V. Phone/Fax

Practice location:
  • Phone: 650-504-8726
  • Fax:
Mailing address:
  • Phone: 650-504-8726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95181654
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95039908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: