Provider Demographics
NPI:1245677293
Name:MANALO, BERNADETTE (NP)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:MANALO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BERNADETTE
Other - Middle Name:
Other - Last Name:MANALO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:7922 GLENCOE DR APT 3
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-4111
Mailing Address - Country:US
Mailing Address - Phone:714-624-9725
Mailing Address - Fax:
Practice Address - Street 1:7922 GLENCOE DR APT 3
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-4111
Practice Address - Country:US
Practice Address - Phone:714-624-9725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23051363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily