Healthcare Provider Details

I. General information

NPI: 1326966086
Provider Name (Legal Business Name): WESLEY MANZANO HCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28027 129TH PL SE
KENT WA
98030-8517
US

IV. Provider business mailing address

28027 129TH PL SE
KENT WA
98030-8517
US

V. Phone/Fax

Practice location:
  • Phone: 206-322-1576
  • Fax:
Mailing address:
  • Phone: 206-322-1576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHMCC.HM.70039750
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: