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NPI Code Detail

MEDICARE: DONNA GAIL MANNING

MEDICARE: DONNA GAIL MANNING
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
1101YA0400XAddiction (Substance Use Disorder) CounselorA044230517CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A044230517OTHERCACCAPP CERTIFICATION

General Provider Information

NPI Number : 1609399088
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONNA GAIL MANNING
Provider Business Mailing Address
First Line : PO BOX 13219
Second Line :
City : COYOTE
State : CA
Zip : 95013-3219
Country : US
Telephone Number : 408-281-6555
Fax Number : 408-463-1015
Provider Business Practice Location Address
First Line : 1659 SCOTT BLVD STE 30
Second Line :
City : SANTA CLARA
State : CA
Zip : 95050-4137
Country : US
Telephone Number : 408-281-6555
Fax Number : 408-463-1015
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2017
Last Update Date : 07/18/2017

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Directions to “ DONNA GAIL MANNING ” Practice Location

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