Provider Demographics
NPI:1053692640
Name:MANALAD, ANTHONY RODRIGUEZ (NP)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:RODRIGUEZ
Last Name:MANALAD
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 CANTERA
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-1261
Mailing Address - Country:US
Mailing Address - Phone:714-757-2771
Mailing Address - Fax:
Practice Address - Street 1:2011 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3503
Practice Address - Country:US
Practice Address - Phone:213-484-4444
Practice Address - Fax:213-413-0081
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily