1588005110 NPI number — MYLENE MANALO DEGUZMAN PHARMD, BCPS, APH

Table of content: MYLENE MANALO DEGUZMAN PHARMD, BCPS, APH (NPI 1588005110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588005110 NPI number — MYLENE MANALO DEGUZMAN PHARMD, BCPS, APH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEGUZMAN
Provider First Name:
MYLENE
Provider Middle Name:
MANALO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD, BCPS, APH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MANALO
Provider Other First Name:
MYLENE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD, BCPS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588005110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4918 S TANGERINE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ONTARIO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91762-7292
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-818-1103
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8510 BALBOA BLVD STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91325-5810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-810-4600
Provider Business Practice Location Address Fax Number:
818-933-0516
Provider Enumeration Date:
07/11/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RPH65899 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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