Provider Demographics
NPI:1699827824
Name:MANOSALVA, JOEL F (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:F
Last Name:MANOSALVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 JOSEPH DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-7312
Mailing Address - Country:US
Mailing Address - Phone:650-588-5145
Mailing Address - Fax:
Practice Address - Street 1:18 JOSEPH DR
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-7312
Practice Address - Country:US
Practice Address - Phone:650-588-5145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63382207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A633820Medicaid
CA00A633820Medicaid
H22399Medicare UPIN