Healthcare Provider Details

I. General information

NPI: 1386463354
Provider Name (Legal Business Name): VANESSA MANALO LEAL BSN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VANESSA ESERJOSE MANALO

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 E ROOSEVELT ST
PHOENIX AZ
85008-4973
US

IV. Provider business mailing address

2837 E TERRACE AVE
GILBERT AZ
85234-1428
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-5332
  • Fax:
Mailing address:
  • Phone: 650-296-3480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN213488
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: