Provider Demographics
NPI:1417287236
Name:BELANDRES, MANUEL MOLDERO
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:MOLDERO
Last Name:BELANDRES
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:MANUEL
Other - Middle Name:MOLDERO
Other - Last Name:BELANDRES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:467 MANZANO PL
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-8022
Mailing Address - Country:US
Mailing Address - Phone:619-482-7738
Mailing Address - Fax:
Practice Address - Street 1:467 MANZANO PL
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-8022
Practice Address - Country:US
Practice Address - Phone:619-482-7738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACFE52548208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery