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General NPI Number Information
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NPI Number | 1740553056
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Entity Type | Individual
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Provider Name | ALEXIS MARIE MANNEH PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/16/2012
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Last Update Date | 02/16/2012
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Provider Practice Location Address
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Address Line | 2100 POWELL ST STE 900
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City | EMERYVILLE
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State | CA
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Zip | 94608-1844
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Country | US
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Telephone | 510-350-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 5741 W CROWLEY AVE
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City | VISALIA
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State | CA
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Zip | 93291-5146
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Country | US
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Telephone | 818-317-8165
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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 | PA21689
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License Number State | CA
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