Provider Demographics
NPI:1689143000
Name:MANALO, PELILIA
Entity Type:Individual
Prefix:
First Name:PELILIA
Middle Name:
Last Name:MANALO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7957 DALE STREET
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-2271
Mailing Address - Country:US
Mailing Address - Phone:714-269-6931
Mailing Address - Fax:
Practice Address - Street 1:7957 DALE STREET
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-2271
Practice Address - Country:US
Practice Address - Phone:714-269-6931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANAMedicaid