Provider Demographics
NPI:1619956596
Name:MANALO, YVONNE SOCORRO (MD)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:SOCORRO
Last Name:MANALO
Suffix:
Gender:F
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 81346
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78468-1346
Mailing Address - Country:US
Mailing Address - Phone:361-887-0067
Mailing Address - Fax:361-883-1484
Practice Address - Street 1:1625 RODD FIELD RD
Practice Address - Street 2:SUITE C
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4926
Practice Address - Country:US
Practice Address - Phone:361-887-0067
Practice Address - Fax:361-887-1484
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5449207RX0202X
PAMD060915L207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5259589OtherAETNA
TX154795201Medicaid
TX8G2171OtherBLUE CROSS BLUE SHIELD
G58243Medicare UPIN
TX8A1395Medicare PIN
TX8G2171OtherBLUE CROSS BLUE SHIELD