Provider Demographics
NPI:1306989116
Name:MANAKAS, VANCE J (MS ATC)
Entity type:Individual
Prefix:MR
First Name:VANCE
Middle Name:J
Last Name:MANAKAS
Suffix:
Gender:M
Credentials:MS ATC
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12228 ARBOR HILL ST
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-3175
Mailing Address - Country:US
Mailing Address - Phone:805-378-1480
Mailing Address - Fax:
Practice Address - Street 1:12228 ARBOR HILL ST
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-3175
Practice Address - Country:US
Practice Address - Phone:805-378-1480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2255A2300XMedicare UPIN