Provider Demographics
NPI:1700773090
Name:FIDEL-EMMANUEL, ANDRES LAYANGLAWIN (CMT)
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:LAYANGLAWIN
Last Name:FIDEL-EMMANUEL
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:ANDRES
Other - Middle Name:LAYANGLAWIN
Other - Last Name:FIDEL EMMANUEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CMT
Mailing Address - Street 1:1146 CANTERBURY
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-3613
Mailing Address - Country:US
Mailing Address - Phone:510-410-5237
Mailing Address - Fax:
Practice Address - Street 1:1146 CANTERBURY
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-3613
Practice Address - Country:US
Practice Address - Phone:510-410-5237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99710225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist