Provider Demographics
NPI:1417436197
Name:MANANGAT, LEAH SANTIANEZ (APRN)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:SANTIANEZ
Last Name:MANANGAT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 TRIDENT DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-7917
Mailing Address - Country:US
Mailing Address - Phone:615-397-0086
Mailing Address - Fax:
Practice Address - Street 1:205 W GRANGER AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4402
Practice Address - Country:US
Practice Address - Phone:209-422-3548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000024582363LF0000X
CA95010433363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily