Provider Demographics
NPI:1851315980
Name:SACAPANO, MANUEL RAMON (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:RAMON
Last Name:SACAPANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12376 PRIMROSE AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1094
Mailing Address - Country:US
Mailing Address - Phone:818-450-4649
Mailing Address - Fax:
Practice Address - Street 1:21530 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716-2608
Practice Address - Country:US
Practice Address - Phone:714-522-2001
Practice Address - Fax:714-522-7503
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77588208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABM426UMedicare PIN