Provider Demographics
NPI:1093962185
Name:MANOTAS, MANUEL ANDRES (PSYD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:ANDRES
Last Name:MANOTAS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SNOWDEN LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1029
Mailing Address - Country:US
Mailing Address - Phone:786-487-5079
Mailing Address - Fax:
Practice Address - Street 1:999 SUTTER ST
Practice Address - Street 2:SUITE 206
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-6023
Practice Address - Country:US
Practice Address - Phone:415-891-9562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26343103TC0700X
103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)