Provider Demographics
NPI:1659742278
Name:MANZANO, CINTHYA NALLELY
Entity Type:Individual
Prefix:MRS
First Name:CINTHYA
Middle Name:NALLELY
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 1:601 SE 12TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73129-4121
Mailing Address - Country:US
Mailing Address - Phone:405-802-6573
Mailing Address - Fax:
Practice Address - Street 1:500 SE GRAND BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73129-4948
Practice Address - Country:US
Practice Address - Phone:405-605-8232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKN0835190491041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool