Provider Demographics
NPI:1336486810
Name:MANALILI, DEANNE RAE MAGCALAS (FNP)
Entity Type:Individual
Prefix:
First Name:DEANNE RAE
Middle Name:MAGCALAS
Last Name:MANALILI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 N GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104
Mailing Address - Country:US
Mailing Address - Phone:619-565-7741
Mailing Address - Fax:
Practice Address - Street 1:630 S RAYMOND AVE STE 340
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105
Practice Address - Country:UM
Practice Address - Phone:626-584-0026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21934363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily