Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 95004035 | CA |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 95004035 | CA |
NPI | 1003362260 |
---|---|
Provider Name | Chriselda Manalo |
First Address | Los Angeles, CA 90027-5969 |
Second Address | Los Angeles, CA 90027-5969 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2016 |
Last Update Date | 28/08/2016 |