Provider Demographics
NPI:1942687553
Name:MANNARINO, IAN SETH
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:SETH
Last Name:MANNARINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 S DIRECTOR ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-4702
Mailing Address - Country:US
Mailing Address - Phone:805-402-7725
Mailing Address - Fax:
Practice Address - Street 1:2570 TEMPLE AVE
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2230
Practice Address - Country:US
Practice Address - Phone:805-402-7725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-04
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program