Provider Demographics
NPI:1760604185
Name:MANALASTAS, RUBY DEGUZMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBY
Middle Name:DEGUZMAN
Last Name:MANALASTAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 G. ARANETA AVENUE
Mailing Address - Street 2:
Mailing Address - City:QUEZON CITY
Mailing Address - State:METRO MANILA
Mailing Address - Zip Code:1100
Mailing Address - Country:PH
Mailing Address - Phone:632-416-2451
Mailing Address - Fax:632-711-4429
Practice Address - Street 1:DEPARTMENT OF MENTAL HEALTH
Practice Address - Street 2:790 GOV. CAMACHO ROAD
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96911
Practice Address - Country:US
Practice Address - Phone:671-647-5354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM0014232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE84567Medicare UPIN