Provider Demographics
NPI:1548307739
Name:MANZANARES, LETICIA A (CAADE INTERN)
Entity type:Individual
Prefix:MS
First Name:LETICIA
Middle Name:A
Last Name:MANZANARES
Suffix:
Gender:F
Credentials:CAADE INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3765 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-5844
Mailing Address - Country:US
Mailing Address - Phone:415-824-8722
Mailing Address - Fax:
Practice Address - Street 1:1735 MISSION STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-0103
Practice Address - Country:US
Practice Address - Phone:415-746-1967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAADE INTERN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)