Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 39546 | CA |
NPI | 1053401596 |
---|---|
Provider Name | Dr. Maria Bautista Manaloto |
First Address | South San Francisco, CA 94080-5404 |
Second Address | South San Francisco, CA 94080-5404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 08/07/2007 |