Provider Demographics
NPI:1558481408
Name:MANANQUIL, GLICITO (DO)
Entity Type:Individual
Prefix:MR
First Name:GLICITO
Middle Name:
Last Name:MANANQUIL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 OFARRELL ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-5803
Mailing Address - Country:US
Mailing Address - Phone:415-982-1177
Mailing Address - Fax:415-362-3888
Practice Address - Street 1:47 OFARRELL ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-5803
Practice Address - Country:US
Practice Address - Phone:415-982-1177
Practice Address - Fax:415-362-3888
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASL2930156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician