Provider Demographics
NPI:1952826687
Name:MANNING, JUDITH ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ELIZABETH
Last Name:MANNING
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:ELIZABETH
Other - Last Name:MANNING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4283 EL CAJON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1289
Mailing Address - Country:US
Mailing Address - Phone:619-152-1743
Mailing Address - Fax:611-952-1896
Practice Address - Street 1:4283 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1289
Practice Address - Country:US
Practice Address - Phone:619-521-1743
Practice Address - Fax:619-521-1896
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program