Provider Demographics
NPI:1285516674
Name:ELEAZAR, KIMBERLY ANNE MANZAN (CMT)
Entity type:Individual
Prefix:
First Name:KIMBERLY ANNE
Middle Name:MANZAN
Last Name:ELEAZAR
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 CASANOVA AVE APT 14
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-6879
Mailing Address - Country:US
Mailing Address - Phone:949-521-4436
Mailing Address - Fax:
Practice Address - Street 1:2100 GARDEN RD
Practice Address - Street 2:BUILDING B SUITE H4
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940
Practice Address - Country:US
Practice Address - Phone:949-521-4436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88205225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist