Provider Demographics
NPI:1790566073
Name:LUO, MANNA I
Entity Type:Individual
Prefix:MS
First Name:MANNA
Middle Name:
Last Name:LUO
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 PALOU AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-2329
Mailing Address - Country:US
Mailing Address - Phone:415-699-1386
Mailing Address - Fax:
Practice Address - Street 1:1518 PALOU AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-2329
Practice Address - Country:US
Practice Address - Phone:415-699-1386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist