Provider Demographics
NPI:1063175461
Name:MANRESA, LINDA (NONE)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MANRESA
Suffix:
Gender:F
Credentials:NONE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 E WASHINGTON AVE UNIT 46
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3230
Mailing Address - Country:US
Mailing Address - Phone:908-630-7440
Mailing Address - Fax:
Practice Address - Street 1:425 VERNON ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2981
Practice Address - Country:US
Practice Address - Phone:908-630-7440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)