Provider Demographics
NPI:1023432267
Name:MANALO, ALBERT
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:MANALO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 CUNNINGHAM AVE STE D
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-1007
Mailing Address - Country:US
Mailing Address - Phone:408-518-1848
Mailing Address - Fax:
Practice Address - Street 1:2635 CUNNINGHAM AVE
Practice Address - Street 2:D
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-1007
Practice Address - Country:US
Practice Address - Phone:408-518-1848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB8525078172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver