Provider Demographics
NPI:1215195813
Name:MANANSALA, GERARDO BALUYUT (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:BALUYUT
Last Name:MANANSALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MARSALA PL
Mailing Address - Street 2:
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503-3137
Mailing Address - Country:US
Mailing Address - Phone:707-980-6738
Mailing Address - Fax:707-649-2739
Practice Address - Street 1:30 MARSALA PL
Practice Address - Street 2:
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503-3137
Practice Address - Country:US
Practice Address - Phone:707-980-6738
Practice Address - Fax:707-649-2739
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1024392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABT030AMedicare PIN