Provider Demographics
NPI:1043650450
Name:MANLY, CYNTHIA ELIZABETH (NP)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ELIZABETH
Last Name:MANLY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2386 FARADAY AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-7222
Mailing Address - Country:US
Mailing Address - Phone:800-930-0803
Mailing Address - Fax:
Practice Address - Street 1:2386 FARADAY AVE STE 110
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7222
Practice Address - Country:US
Practice Address - Phone:800-930-0803
Practice Address - Fax:619-383-6701
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP12331363LP0808X
AZ254231363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW416OtherPCSD MEDICARE #