Provider Demographics
NPI:1114551439
Name:MANALASTAS, ARIANE TYRA DUMALUS
Entity Type:Individual
Prefix:
First Name:ARIANE TYRA
Middle Name:DUMALUS
Last Name:MANALASTAS
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 1:825 S HOBART BLVD APT 302
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-6606
Mailing Address - Country:US
Mailing Address - Phone:310-955-6301
Mailing Address - Fax:
Practice Address - Street 1:825 S HOBART BLVD APT 302
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-6606
Practice Address - Country:US
Practice Address - Phone:310-955-6301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4360224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant