Provider Demographics
NPI:1508448135
Name:MANZANO, KATHERINE ESCARLETH
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ESCARLETH
Last Name:MANZANO
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 1:19744 VANOWEN ST
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-3928
Mailing Address - Country:US
Mailing Address - Phone:747-229-1436
Mailing Address - Fax:
Practice Address - Street 1:19744 VANOWEN ST
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-3928
Practice Address - Country:US
Practice Address - Phone:747-229-1436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA710647164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse