Provider Demographics
NPI:1194473272
Name:MANU, KIERNAN RILEY
Entity Type:Individual
Prefix:
First Name:KIERNAN
Middle Name:RILEY
Last Name:MANU
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 1:1317 JAMES CT
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3150
Mailing Address - Country:US
Mailing Address - Phone:650-889-9984
Mailing Address - Fax:
Practice Address - Street 1:139 HUGO ST APT 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-2760
Practice Address - Country:US
Practice Address - Phone:650-797-2327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician