Individual
EDGAR IVAN MANZANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2225 CHALLENGER WAY, SANTA ROSA, CA 95407-5441
(707) 565-4970
Mailing address
2225 CHALLENGER WAY, SANTA ROSA, CA 95407-5441
(707) 565-4970
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
CA
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
373H00000X
Day Training/Habilitation Specialist
Primary
—
CA
Other
Enumeration date
11/02/2023
Last updated
03/23/2026
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