Provider Demographics
NPI:1376601518
Name:MANIAGO, GLADYS (NP)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:MANIAGO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GLADYS
Other - Middle Name:
Other - Last Name:TUMALIUAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:10616 DEERING AVE
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-2234
Mailing Address - Country:US
Mailing Address - Phone:818-468-7200
Mailing Address - Fax:
Practice Address - Street 1:7515 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-1949
Practice Address - Country:US
Practice Address - Phone:818-947-9426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13503363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health