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General NPI Number Information
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NPI Number | 1528667979
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Entity Type | Individual
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Provider Name | ADELINE RAE MANNINO
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Gender | Female
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Dates
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Enumeration Date | 10/17/2020
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Last Update Date | 10/17/2020
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Provider Practice Location Address
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Address Line | 3701 HACIENDA ST
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City | SAN MATEO
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State | CA
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Zip | 94403-4366
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Country | US
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Telephone | 650-204-9695
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Fax |
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Provider Business Mailing Address
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Address Line | 1414 KANSAS ST APT 4
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City | SAN FRANCISCO
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State | CA
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Zip | 94107-3293
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Country | US
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Telephone | 631-505-7515
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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