Healthcare Provider Details

I. General information

NPI: 1396615381
Provider Name (Legal Business Name): ALEXIS PURINO MANALO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 POMONA RD # 230
CORONA CA
92878-4324
US

IV. Provider business mailing address

780 N TOWNE AVE
CLAREMONT CA
91711-4186
US

V. Phone/Fax

Practice location:
  • Phone: 818-605-7976
  • Fax:
Mailing address:
  • Phone: 818-605-7976
  • Fax: 818-337-1483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95037521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: