MEDICARE: MARIA C. MANALO M.D., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	11659	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11659	OTHER	NV	MEDICAL LICENSE
2	193620	OTHER	NV	AM BOARD OF INTERNAL MEDI

General Provider Information

NPI Number	:	1043481153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIA C. MANALO M.D., P.C.

Provider Business Mailing Address
First Line	:	2711 N TENAYA WAY
Second Line	:	SUITE 104
City	:	LAS VEGAS
State	:	NV
Zip	:	89128
Country	:	US
Telephone Number	:	702-658-9874
Fax Number	:

Provider Business Practice Location Address
First Line	:	8775 WEST DEER SPRINGS WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4409
Country	:	US
Telephone Number	:	702-658-9874
Fax Number	:	702-658-9874

Authorized Official
Title or Position	:	OWNER
Name	:	MARIA CHRISTINA MANALO
Credential	:	M.D.
Telephone Number	:	702-658-9874

Provider Enumeration Date	:	03/17/2008
Last Update Date	:	03/07/2023

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