Provider Demographics
NPI:1982608576
Name:MANN, SIRINTORN R (PA-C)
Entity type:Individual
Prefix:MS
First Name:SIRINTORN
Middle Name:R
Last Name:MANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:907 SAN RAMON VALLEY BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-4036
Mailing Address - Country:US
Mailing Address - Phone:925-837-4202
Mailing Address - Fax:925-838-3224
Practice Address - Street 1:907 SAN RAMON VALLEY BLVD
Practice Address - Street 2:STE 202
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4036
Practice Address - Country:US
Practice Address - Phone:925-837-4202
Practice Address - Fax:925-838-3224
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA16643363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA16643OtherPHYSICIAN ASSIST. LICENSE
MR0933766OtherFED DEA #
P92892Medicare UPIN