Provider Demographics
NPI:1033920970
Name:MANIAGO, AMELIA AZUCENA CASTRO
Entity type:Individual
Prefix:
First Name:AMELIA AZUCENA
Middle Name:CASTRO
Last Name:MANIAGO
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 1:15607 DERRICO LN
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-1425
Mailing Address - Country:US
Mailing Address - Phone:704-737-9310
Mailing Address - Fax:
Practice Address - Street 1:1233 E YORBA LINDA BLVD
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3830
Practice Address - Country:US
Practice Address - Phone:714-993-3345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90648183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist