Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 103377 | CA |
NPI | 1104204023 |
---|---|
Provider Name | Dr. Taylor Manalili |
First Address | Irvine, CA 92612-1552 |
Second Address | Irvine, CA 92612-1552 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2015 |
Last Update Date | 02/01/2019 |