Provider Demographics
NPI:1639328412
Name:WILSON-MANIGAT, BRANDYE (MD)
Entity type:Individual
Prefix:
First Name:BRANDYE
Middle Name:
Last Name:WILSON-MANIGAT
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 1:50 ALESSANDRO PL
Mailing Address - Street 2:SUITE 310
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3149
Mailing Address - Country:US
Mailing Address - Phone:626-796-9114
Mailing Address - Fax:626-796-8523
Practice Address - Street 1:50 ALESSANDRO PL
Practice Address - Street 2:SUITE 310
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3149
Practice Address - Country:US
Practice Address - Phone:626-796-9114
Practice Address - Fax:626-796-8523
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95658207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology