MEDICARE: MAIKA MANALASTAS DO

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	2080N0001X	Neonatal-Perinatal Medicine Physician	20A23371	CA
2	2080N0001X	Neonatal-Perinatal Medicine Physician	009051	AZ
3	2080N0001X	Neonatal-Perinatal Medicine Physician	036.145944	IL
4	208000000X	Pediatrics Physician	125066375	IL

General Provider Information

NPI Number	:	1144615881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAIKA MANALASTAS DO

Provider Business Mailing Address
First Line	:	350 RHODE ISLAND ST STE 200
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94103-5188
Country	:	US
Telephone Number	:	415-366-7574
Fax Number	:

Provider Business Practice Location Address
First Line	:	1860 PENNSYLVANIA AVE STE 145
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-3547
Country	:	US
Telephone Number	:	707-646-4051
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2015
Last Update Date	:	05/18/2026

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