Provider Demographics
NPI:1386681153
Name:MANA, STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:MANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SUTHEP
Other - Middle Name:
Other - Last Name:MANASANTIVONGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:DEPT. LA 23039
Mailing Address - Street 2:ATTENTION: MAGGIE NOLES MS 6160
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-3039
Mailing Address - Country:US
Mailing Address - Phone:562-741-4461
Mailing Address - Fax:562-741-4413
Practice Address - Street 1:11525 BROOKSHIRE AVE
Practice Address - Street 2:SUITE # 301
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4985
Practice Address - Country:US
Practice Address - Phone:562-862-3684
Practice Address - Fax:562-862-7145
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32685207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
010711OtherHEALTH NET ID #
00A326850OtherBLUE SHIELD ID #
CA00A326850Medicaid
110224009OtherRAILROAD
CAWA32685HMedicare PIN
110224009OtherRAILROAD
A84383Medicare UPIN
CA00A326850Medicaid