Provider Demographics
NPI:1629265194
Name:MANN, BRENDA LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:MANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10760 SCRIPPS RANCH BLVD
Mailing Address - Street 2:APT 202
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-6002
Mailing Address - Country:US
Mailing Address - Phone:619-453-2800
Mailing Address - Fax:
Practice Address - Street 1:10666 N TORREY PINES RD
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1027
Practice Address - Country:US
Practice Address - Phone:858-784-5894
Practice Address - Fax:858-784-5960
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA2130363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical