MEDICARE: LISA MANAHAN MS, LCGC

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	170300000X	Genetic Counselor (M.S.)	GC001961	CA

General Provider Information

NPI Number	:	1912830597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MANAHAN MS, LCGC

Provider Business Mailing Address
First Line	:	4910 DIRECTORS PL STE 200
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3814
Country	:	US
Telephone Number	:	858-249-5428
Fax Number	:	858-249-5455

Provider Business Practice Location Address
First Line	:	4910 DIRECTORS PL STE 200
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3814
Country	:	US
Telephone Number	:	858-249-5428
Fax Number	:	858-249-5455

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

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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