Provider Demographics
NPI:1043327240
Name:MANITSAS, CHRIS S (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:S
Last Name:MANITSAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 GELLERT DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132
Mailing Address - Country:US
Mailing Address - Phone:415-664-4761
Mailing Address - Fax:
Practice Address - Street 1:506 GELLERT DRIVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132
Practice Address - Country:US
Practice Address - Phone:415-664-4761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA17036207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A170362Medicaid
CA00A170360Medicare ID - Type Unspecified