Provider Demographics
NPI:1013563626
Name:MUASAU, MANUMALO JACOB
Entity Type:Individual
Prefix:
First Name:MANUMALO
Middle Name:JACOB
Last Name:MUASAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22712 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4208
Mailing Address - Country:US
Mailing Address - Phone:510-856-9760
Mailing Address - Fax:
Practice Address - Street 1:22712 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4208
Practice Address - Country:US
Practice Address - Phone:510-856-9760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-11
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker