Provider Demographics
NPI:1477663854
Name:MANIMTIM, DANILO RAYMUNDO (MD)
Entity Type:Individual
Prefix:DR
First Name:DANILO
Middle Name:RAYMUNDO
Last Name:MANIMTIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 N FRESNO ST
Mailing Address - Street 2:101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-8606
Mailing Address - Country:US
Mailing Address - Phone:559-435-4168
Mailing Address - Fax:
Practice Address - Street 1:6101 N FRESNO ST
Practice Address - Street 2:101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8606
Practice Address - Country:US
Practice Address - Phone:559-435-4168
Practice Address - Fax:559-435-6733
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36441207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A364410Medicaid
CA00A364410Medicare ID - Type Unspecified
CA00A364410Medicaid