Provider Demographics
NPI:1932263324
Name:MANUEL, MARY ANN
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:MANUEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:DELAMATER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HAD
Mailing Address - Street 1:4801 WILSON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309
Mailing Address - Country:US
Mailing Address - Phone:661-832-5944
Mailing Address - Fax:661-832-4714
Practice Address - Street 1:4801 WILSON RD
Practice Address - Street 2:SUITE A
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309
Practice Address - Country:US
Practice Address - Phone:661-832-5944
Practice Address - Fax:661-832-4714
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA1945237600000X
332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Not Answered332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA0019450OtherMEDI CAL