Provider Demographics
NPI:1417439647
Name:MANNING, MARK PATRICK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:PATRICK
Last Name:MANNING
Suffix:
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 1:7830 CLAIREMONT MESA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1632
Mailing Address - Country:US
Mailing Address - Phone:858-268-1111
Mailing Address - Fax:858-268-0761
Practice Address - Street 1:7830 CLAIREMONT MESA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1632
Practice Address - Country:US
Practice Address - Phone:858-268-1111
Practice Address - Fax:858-268-0761
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009680363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily