Provider Demographics
NPI:1235781261
Name:MANZE, SAFINA NAMATOVU I (N/A)
Entity Type:Individual
Prefix:MISS
First Name:SAFINA
Middle Name:NAMATOVU
Last Name:MANZE
Suffix:I
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9115 SW OLESON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6876
Mailing Address - Country:US
Mailing Address - Phone:971-236-0915
Mailing Address - Fax:
Practice Address - Street 1:10445 SE COOK CT APT 203
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97222-1517
Practice Address - Country:US
Practice Address - Phone:541-207-6063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician