Provider Demographics
NPI:1811411804
Name:MANZO, SANDRA (MS-CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:MANZO
Suffix:
Gender:F
Credentials:MS-CCC-SLP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:ESPARZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS-CCC-SLP
Mailing Address - Street 1:3939 BERNARD STREET
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306
Mailing Address - Country:US
Mailing Address - Phone:661-230-6230
Mailing Address - Fax:661-348-4390
Practice Address - Street 1:3939 BERNARD STREET
Practice Address - Street 2:SUITE 6
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306
Practice Address - Country:US
Practice Address - Phone:661-230-6230
Practice Address - Fax:661-348-4390
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23638235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist