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Individual

MARCELLA T MANIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2178 JOHNSON AVE, SLO, CA 93401
(805) 781-4700
Mailing address
1220 BENNETT WAY SPC 97, TEMPLETON, CA 93465-3623
(805) 286-4108

Taxonomy

Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
PT26027
CA

Other

Enumeration date
04/21/2010
Last updated
04/21/2010
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