Healthcare Provider Details

I. General information

NPI: 1356220669
Provider Name (Legal Business Name): YESSICA CARLIBETH MANZANARES BARBEITO P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16808 SW 137TH AVE APT 928
MIAMI FL
33177-2378
US

IV. Provider business mailing address

16808 SW 137TH AVE APT 928
MIAMI FL
33177-2378
US

V. Phone/Fax

Practice location:
  • Phone: 786-312-6464
  • Fax:
Mailing address:
  • Phone: 786-312-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3075
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number25-376
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3075
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: