Provider Demographics
NPI:1801121983
Name:MANALANG, GRACE DIVINE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:DIVINE
Last Name:MANALANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28237 NEWHALL RANCH RD
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-0986
Mailing Address - Country:US
Mailing Address - Phone:661-257-4242
Mailing Address - Fax:661-294-0020
Practice Address - Street 1:28237 NEWHALL RANCH RD
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-0986
Practice Address - Country:US
Practice Address - Phone:661-257-4242
Practice Address - Fax:661-294-0020
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant