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General NPI Number Information
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NPI Number | 1619023769
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Entity Type | Individual
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Provider Name | JEFFREY D MANESE PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 11/17/2007
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Provider Practice Location Address
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Address Line | 45 CASTRO ST SUITE 432
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City | SAN FRANCISCO
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State | CA
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Zip | 94114-1010
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Country | US
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Telephone | 415-865-3737
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Fax |
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Provider Business Mailing Address
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Address Line | 4333 FLEMING AVE
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City | OAKLAND
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State | CA
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Zip | 94619-2529
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Country | US
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Telephone | 510-261-5962
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 18366
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT20351
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License Number State | CA
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