Provider Demographics
NPI:1528016847
Name:MANALE, JORGE EFREN (OT)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:EFREN
Last Name:MANALE
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 W BEVERLY BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4265
Mailing Address - Country:US
Mailing Address - Phone:562-338-1609
Mailing Address - Fax:562-927-5820
Practice Address - Street 1:7340 FIRESTONE BLVD
Practice Address - Street 2:STE 123
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4100
Practice Address - Country:US
Practice Address - Phone:562-927-5820
Practice Address - Fax:323-721-3396
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 4566225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOT4566AMedicare ID - Type Unspecified