Provider Demographics
NPI:1417772104
Name:MANZANA, HELEN M (LICENSED CCFFHS)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:M
Last Name:MANZANA
Suffix:
Gender:F
Credentials:LICENSED CCFFHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-691 KAAOKI PL
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-1210
Mailing Address - Country:US
Mailing Address - Phone:808-391-1164
Mailing Address - Fax:
Practice Address - Street 1:94-691 KAAOKI PL
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1210
Practice Address - Country:US
Practice Address - Phone:808-391-1164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home