Provider Demographics
NPI:1467568352
Name:MANALOTO, MARIA CORAZON (DDS)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CORAZON
Last Name:MANALOTO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CORAZON
Other - Middle Name:BAUTISTA
Other - Last Name:MANALOTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2215 SANTA CLARA AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501
Mailing Address - Country:US
Mailing Address - Phone:510-521-0420
Mailing Address - Fax:510-865-1179
Practice Address - Street 1:2215 SANTA CLARA AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501
Practice Address - Country:US
Practice Address - Phone:510-521-0420
Practice Address - Fax:510-865-1179
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41277122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist