Provider Demographics
NPI:1497779730
Name:MANASEVIT, STEVEN I (PA-C)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:I
Last Name:MANASEVIT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11550 INDIAN HILLS RD STE 241
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1202
Mailing Address - Country:US
Mailing Address - Phone:818-361-0136
Mailing Address - Fax:818-365-1259
Practice Address - Street 1:11550 INDIAN HILLS RD STE 241
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1202
Practice Address - Country:US
Practice Address - Phone:818-361-0136
Practice Address - Fax:818-365-1259
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15050363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPA15050BMedicare ID - Type Unspecified