Provider Demographics
NPI:1336679760
Name:MANIU, KRYSTINA MAE (MS)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTINA
Middle Name:MAE
Last Name:MANIU
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34272 HIDDEN COVE DR
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-2595
Mailing Address - Country:US
Mailing Address - Phone:909-659-1563
Mailing Address - Fax:
Practice Address - Street 1:2500 N PALM CANYON DR STE A4
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-1866
Practice Address - Country:US
Practice Address - Phone:760-424-5602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8700101Y00000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor