Provider Demographics
NPI:1134215049
Name:MANALO, MITCHELLE OLILA (RNP)
Entity type:Individual
Prefix:MS
First Name:MITCHELLE
Middle Name:OLILA
Last Name:MANALO
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 XANADU WAY
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-5508
Mailing Address - Country:US
Mailing Address - Phone:855-701-7955
Mailing Address - Fax:
Practice Address - Street 1:1000 S. HILLS RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CALIFORNIA
Practice Address - Zip Code:93003
Practice Address - Country:UM
Practice Address - Phone:855-701-7955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA494350163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult