1447560339 NPI number — MARY ANN MERCADO LUGOD-MANALAD NP-C

Table of content: MARY ANN MERCADO LUGOD-MANALAD NP-C (NPI 1447560339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447560339 NPI number — MARY ANN MERCADO LUGOD-MANALAD NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUGOD-MANALAD
Provider First Name:
MARY ANN
Provider Middle Name:
MERCADO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MANALAD
Provider Other First Name:
MARY ANN
Provider Other Middle Name:
LUGOD
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1447560339
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4934 BELLA COLLINA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCEANSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92056-1913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-295-6053
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 SANTA FE DR
Provider Second Line Business Practice Location Address:
STE 112
Provider Business Practice Location Address City Name:
ENCINITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92024-5110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-632-9600
Provider Business Practice Location Address Fax Number:
760-632-9669
Provider Enumeration Date:
10/14/2010

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: 363LF0000X , with the licence number:  20249 , 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)





Copyright © 2007-2025 www.npivalidator.com