Provider Demographics
NPI:1700656089
Name:SALES, IMELDA MANALO (FNP)
Entity Type:Individual
Prefix:
First Name:IMELDA
Middle Name:MANALO
Last Name:SALES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 FRIENDLY VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-7899
Mailing Address - Country:US
Mailing Address - Phone:954-281-9886
Mailing Address - Fax:
Practice Address - Street 1:1417 FRIENDLY VALLEY LN
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-7899
Practice Address - Country:US
Practice Address - Phone:954-281-9886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty