Provider Demographics
NPI:1104621754
Name:MANUS, ROBERT II
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:MANUS
Suffix:II
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 1:1114 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-6062
Mailing Address - Country:US
Mailing Address - Phone:657-636-2142
Mailing Address - Fax:
Practice Address - Street 1:1207 E FRUIT ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4296
Practice Address - Country:US
Practice Address - Phone:714-953-9373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-05-28
Deactivation Date:2025-05-05
Deactivation Code:
Reactivation Date:2025-05-27
Provider Licenses
StateLicense IDTaxonomies
CAR1593970125101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)