Healthcare Provider Details

I. General information

NPI: 1316855901
Provider Name (Legal Business Name): MANIFA AVANESIAN VANIGH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 RIVERGRADE RD STE C110
BALDWIN PARK CA
91706-1458
US

IV. Provider business mailing address

333 MYRTLE ST APT 5
GLENDALE CA
91203-2254
US

V. Phone/Fax

Practice location:
  • Phone: 626-939-7013
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number92768
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: