Provider Demographics
NPI:1457579864
Name:MANCA, DEBRA WATERHOUSE (RD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:WATERHOUSE
Last Name:MANCA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:WATERHOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:23 WHITE COURT
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611
Mailing Address - Country:US
Mailing Address - Phone:510-339-3848
Mailing Address - Fax:510-339-3858
Practice Address - Street 1:23 ORINDA WAY
Practice Address - Street 2:SUITE 308
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563
Practice Address - Country:US
Practice Address - Phone:510-339-3848
Practice Address - Fax:510-339-3858
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
689963133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered