Provider Demographics
NPI:1609811868
Name:ORELLANA, MANUEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:A
Last Name:ORELLANA
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:PO BOX 4488
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204
Mailing Address - Country:US
Mailing Address - Phone:209-941-8073
Mailing Address - Fax:209-941-0230
Practice Address - Street 1:2626 N CALIFORNIA ST
Practice Address - Street 2:#F
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204
Practice Address - Country:US
Practice Address - Phone:209-941-8073
Practice Address - Fax:209-941-0230
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA500440207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A500440OtherMEDICARE PROVIDER IDENTIFICATION NUMBER
CA00A500440OtherMEDICARE PROVIDER IDENTIFICATION NUMBER
F18105Medicare UPIN