Provider Demographics
NPI:1275387151
Name:MANIEGO, ALEXANDRA JEAN A
Entity Type:Individual
Prefix:
First Name:ALEXANDRA JEAN
Middle Name:A
Last Name:MANIEGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 ANTELOPE CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-3946
Mailing Address - Country:US
Mailing Address - Phone:707-570-7185
Mailing Address - Fax:
Practice Address - Street 1:313 LENNON LN STE 100
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2460
Practice Address - Country:US
Practice Address - Phone:925-465-1585
Practice Address - Fax:925-476-4843
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician