Provider Demographics
NPI:1639463417
Name:DANILO R MANIMTIM M D INC DANILO R MANIMTIM PRES
Entity Type:Organization
Organization Name:DANILO R MANIMTIM M D INC DANILO R MANIMTIM PRES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANILO
Authorized Official - Middle Name:R
Authorized Official - Last Name:MANIMTIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-435-4168
Mailing Address - Street 1:6101 N FRESNO ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-8606
Mailing Address - Country:US
Mailing Address - Phone:559-435-4168
Mailing Address - Fax:559-435-6733
Practice Address - Street 1:6101 N FRESNO ST STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8606
Practice Address - Country:US
Practice Address - Phone:559-435-4168
Practice Address - Fax:559-435-6733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36441207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A364410Medicaid
CAA28088Medicare UPIN