Provider Demographics
NPI:1346284452
Name:BIRD, MANUELA Y (NP)
Entity Type:Individual
Prefix:
First Name:MANUELA
Middle Name:Y
Last Name:BIRD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18564 US HIGHWAY 18
Mailing Address - Street 2:SUITE 105
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2312
Mailing Address - Country:US
Mailing Address - Phone:760-242-7777
Mailing Address - Fax:
Practice Address - Street 1:18564 US HIGHWAY 18
Practice Address - Street 2:STE 105
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2312
Practice Address - Country:US
Practice Address - Phone:760-242-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMP5944363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily