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NPI Code Detail

MEDICARE: MRS. YESENIA GUADALUPE MANZO-MEDA MSW

MEDICARE: MRS. YESENIA GUADALUPE MANZO-MEDA MSW
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
11041C0700XClinical Social Worker105061CA

General Provider Information

NPI Number : 1598071136
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. YESENIA GUADALUPE MANZO-MEDA MSW
Provider Business Mailing Address
First Line : 1940 E DEERE AVE STE 100
Second Line :
City : SANTA ANA
State : CA
Zip : 92705-5718
Country : US
Telephone Number : 714-923-8237
Fax Number :
Provider Business Practice Location Address
First Line : 1940 E DEERE AVE STE 100
Second Line :
City : SANTA ANA
State : CA
Zip : 92705-5718
Country : US
Telephone Number : 714-923-8237
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2010
Last Update Date : 11/09/2021

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