Provider Demographics
NPI:1710055595
Name:CONTRERAS, MANUEL N (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:N
Last Name:CONTRERAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2601 ALTAMIRA DR
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-1904
Mailing Address - Country:US
Mailing Address - Phone:626-913-4294
Mailing Address - Fax:626-872-6490
Practice Address - Street 1:9238 1/2 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1922
Practice Address - Country:US
Practice Address - Phone:626-872-6499
Practice Address - Fax:626-872-6490
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2011-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA-34444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A-84632Medicare PIN