1760895577 NPI number — MRS. JESSINA MARIE MANIO (STEDMAN IS MAIDEN) ATC

Table of content: MRS. JESSINA MARIE MANIO (STEDMAN IS MAIDEN) ATC (NPI 1760895577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760895577 NPI number — MRS. JESSINA MARIE MANIO (STEDMAN IS MAIDEN) ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANIO (STEDMAN IS MAIDEN)
Provider First Name:
JESSINA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEDMAN
Provider Other First Name:
JESSINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760895577
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1530 CONCORDIA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92612-3203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-214-3246
Provider Business Mailing Address Fax Number:
949-214-3246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1530 CONCORDIA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92612-3203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-214-3246
Provider Business Practice Location Address Fax Number:
949-214-3246
Provider Enumeration Date:
06/09/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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