Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 4301063450 | MI |
Y | 208000000X | Pediatrician | 42024 | AZ |
NPI | 1144259391 |
---|---|
Provider Name | Dr. Angela Gloria Manansala |
First Address | Tucson, AZ 85704-3813 |
Second Address | Tucson, AZ 85704-3813 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2006 |
Last Update Date | 02/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104322316 | (05) | MI |
436721 | (05) | AZ |
436721 | AHCCCS (01) | AZ |
AM063450 | BC/BS OF MICHIGAN (01) | MI |
G66400 | (02) | MI |