Provider Demographics
NPI:1003362260
Name:MANALO, CHRISELDA
Entity Type:Individual
Prefix:
First Name:CHRISELDA
Middle Name:
Last Name:MANALO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4867 W SUNSET BLVD
Mailing Address - Street 2:6TH FLOOR - INTENSIVE CARE UNIT
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5969
Mailing Address - Country:US
Mailing Address - Phone:323-783-9644
Mailing Address - Fax:323-783-0170
Practice Address - Street 1:4867 W SUNSET BLVD
Practice Address - Street 2:6TH FLOOR - INTENSIVE CARE UNIT
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5969
Practice Address - Country:US
Practice Address - Phone:323-783-9644
Practice Address - Fax:323-783-0170
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004035363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health