Provider Demographics
NPI:1073329579
Name:MESTAS, MANUEL EDWARD JR
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:EDWARD
Last Name:MESTAS
Suffix:JR
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 1:230 N COLLEGE DR APT F7
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4672
Mailing Address - Country:US
Mailing Address - Phone:805-260-3046
Mailing Address - Fax:
Practice Address - Street 1:230 N COLLEGE DR APT F7
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4672
Practice Address - Country:US
Practice Address - Phone:805-260-3046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)