MEDICARE: KRYSTAL MANNING LPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	167G00000X	Licensed Psychiatric Technician	PT30597	CA

General Provider Information

NPI Number	:	1346412566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTAL MANNING LPT

Provider Business Mailing Address
First Line	:	8300 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-3493
Country	:	US
Telephone Number	:	323-525-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	8300 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-3493
Country	:	US
Telephone Number	:	323-525-6400
Fax Number	:	323-565-2133

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2008
Last Update Date	:	11/04/2024

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