Provider Demographics
NPI:1598774044
Name:MANALO, MELISSA RILLO (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RILLO
Last Name:MANALO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3400 W BALL RD STE 210
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3737
Mailing Address - Country:US
Mailing Address - Phone:714-826-2380
Mailing Address - Fax:714-826-2873
Practice Address - Street 1:3400 W BALL ROAD
Practice Address - Street 2:SUITE 206
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804
Practice Address - Country:US
Practice Address - Phone:714-826-2380
Practice Address - Fax:714-826-2873
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2021-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA64278208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1740389733OtherCMS