Provider Demographics
NPI:1699012195
Name:MANABAT, VIOLETA E (DMD)
Entity Type:Individual
Prefix:
First Name:VIOLETA
Middle Name:E
Last Name:MANABAT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10945 SOUTH ST
Mailing Address - Street 2:201A
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-5341
Mailing Address - Country:US
Mailing Address - Phone:562-402-2223
Mailing Address - Fax:562-924-7594
Practice Address - Street 1:10945 SOUTH ST
Practice Address - Street 2:201A
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-5341
Practice Address - Country:US
Practice Address - Phone:562-402-2223
Practice Address - Fax:562-924-7594
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA262011223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics