Provider Demographics
NPI:1982613592
Name:MANUEL L H CANGA MD INCORPORATED
Entity type:Organization
Organization Name:MANUEL L H CANGA MD INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:L H
Authorized Official - Last Name:CANGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-862-2991
Mailing Address - Street 1:1248 MAIN ST
Mailing Address - Street 2:STE D
Mailing Address - City:NEWMAN
Mailing Address - State:CA
Mailing Address - Zip Code:95360-1325
Mailing Address - Country:US
Mailing Address - Phone:209-862-2991
Mailing Address - Fax:209-862-4105
Practice Address - Street 1:1248 MAIN ST
Practice Address - Street 2:STE D
Practice Address - City:NEWMAN
Practice Address - State:CA
Practice Address - Zip Code:95360-1325
Practice Address - Country:US
Practice Address - Phone:209-862-2991
Practice Address - Fax:209-862-4105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A461730Medicaid
CA00A461730Medicare ID - Type Unspecified
CA00A461730Medicaid