Provider Demographics
NPI:1174344964
Name:ONESTARFISH
Entity type:Organization
Organization Name:ONESTARFISH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:MANUEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:831-663-7807
Mailing Address - Street 1:484B WASHINGTON ST # 113
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-3030
Mailing Address - Country:US
Mailing Address - Phone:831-204-0230
Mailing Address - Fax:
Practice Address - Street 1:696 CASANOVA AVE APT 19
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-6860
Practice Address - Country:US
Practice Address - Phone:831-204-0230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty