Provider Demographics
NPI:1477313385
Name:MANESTAR, ISABELLA TATJANA (BCAT)
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:TATJANA
Last Name:MANESTAR
Suffix:
Gender:F
Credentials:BCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1084 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-4512
Mailing Address - Country:US
Mailing Address - Phone:310-513-3142
Mailing Address - Fax:
Practice Address - Street 1:21515 HAWTHORNE BLVD # GL-100
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-6501
Practice Address - Country:US
Practice Address - Phone:424-571-2618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician