Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | A82037 | CA |
NPI | 1003857475 |
---|---|
Provider Name | Mano Shanaa |
First Address | Woodland Hills, CA 91367-1833 |
Second Address | Woodland Hills, CA 91367-6701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 13/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A820370 | (05) | CA |
00A820370 | BLUE SHIELD (01) | CA |
H87121 | (02) | CA |