Provider Demographics
NPI:1801968557
Name:MANALO, RODRIGO H (MD)
Entity type:Individual
Prefix:
First Name:RODRIGO
Middle Name:H
Last Name:MANALO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RODRIGO
Other - Middle Name:H
Other - Last Name:MANALO
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1800 HARRISON ST FL 7
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3429
Mailing Address - Country:US
Mailing Address - Phone:510-625-6262
Mailing Address - Fax:
Practice Address - Street 1:1550 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6901
Practice Address - Country:US
Practice Address - Phone:707-427-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43254208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G432540Medicaid
CA00G432540Medicaid
00G432540Medicare ID - Type Unspecified