Provider Demographics
NPI:1619320041
Name:MANAHAN, CATHERINE REYES (DDS)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:REYES
Last Name:MANAHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:MANZANO
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:147 W ROUTE 66 # 422
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6208
Mailing Address - Country:US
Mailing Address - Phone:909-210-8909
Mailing Address - Fax:
Practice Address - Street 1:15911 POMONA RINCON RD STE 120
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-5567
Practice Address - Country:US
Practice Address - Phone:909-497-9449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6585122300000X
CA100468122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist