Provider Demographics
NPI:1740389733
Name:MELISSA R MANALO MD INC
Entity Type:Organization
Organization Name:MELISSA R MANALO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:KILLO
Authorized Official - Last Name:MANALO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-826-2380
Mailing Address - Street 1:3400 WEST BALL ROAD
Mailing Address - Street 2:#206
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804
Mailing Address - Country:US
Mailing Address - Phone:714-826-2380
Mailing Address - Fax:714-826-2873
Practice Address - Street 1:3400 WEST BALL ROAD
Practice Address - Street 2:#206
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804
Practice Address - Country:US
Practice Address - Phone:714-826-2380
Practice Address - Fax:714-826-2873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64278208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty