Provider Demographics
NPI:1033564869
Name:KUMAR, MANISH
Entity Type:Individual
Prefix:
First Name:MANISH
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23637 LOS GRANDES ST
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1123
Mailing Address - Country:US
Mailing Address - Phone:949-309-1275
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF PSYCHIATRY 3601 4TH ST
Practice Address - Street 2:TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-0001
Practice Address - Country:US
Practice Address - Phone:806-743-6162
Practice Address - Fax:806-743-1262
Is Sole Proprietor?:No
Enumeration Date:2016-04-29
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP100561332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry