Provider Demographics
NPI:1841851052
Name:MANZO, YARELI LIZBETH
Entity type:Individual
Prefix:
First Name:YARELI
Middle Name:LIZBETH
Last Name:MANZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7171 BOWLING DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2043
Mailing Address - Country:US
Mailing Address - Phone:916-883-8167
Mailing Address - Fax:916-441-0286
Practice Address - Street 1:7171 BOWLING DR STE 300
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2043
Practice Address - Country:US
Practice Address - Phone:916-883-8167
Practice Address - Fax:510-569-4589
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 106S00000X, 171M00000X, 390200000X
CA129849225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program