Provider Demographics
NPI:1790590453
Name:PABLA, MANJU (LVN)
Entity type:Individual
Prefix:
First Name:MANJU
Middle Name:
Last Name:PABLA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:MANJU
Other - Middle Name:
Other - Last Name:CHAUDHARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16744 VICTORIAN TRL
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:CA
Mailing Address - Zip Code:95330-8835
Mailing Address - Country:US
Mailing Address - Phone:209-200-0320
Mailing Address - Fax:
Practice Address - Street 1:494 BLOSSOM WAY
Practice Address - Street 2:
Practice Address - City:CHERRYLAND
Practice Address - State:CA
Practice Address - Zip Code:94541-1948
Practice Address - Country:US
Practice Address - Phone:510-582-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA725035164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse