Healthcare Provider Details

I. General information

NPI: 1699751222
Provider Name (Legal Business Name): EVELYN MANALILI MUSNI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EVELYN YANGA MANAILI M.D.

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 MOWRY AVE STE 200
FREMONT CA
94538-1730
US

IV. Provider business mailing address

2 JIB CT
PLEASANT HILL CA
94523-1208
US

V. Phone/Fax

Practice location:
  • Phone: 510-790-2202
  • Fax: 510-790-2806
Mailing address:
  • Phone: 925-691-9718
  • Fax: 925-691-9718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberA82026
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License NumberA82026
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: