Provider Demographics
NPI:1831414044
Name:MANALO, LORI (CFA)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:MANALO
Suffix:
Gender:F
Credentials:CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11107 BUD RHODEN RD
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-8630
Mailing Address - Country:US
Mailing Address - Phone:941-531-7313
Mailing Address - Fax:
Practice Address - Street 1:11107 BUD RHODEN RD
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-8630
Practice Address - Country:US
Practice Address - Phone:941-531-7313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL111667246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant