Healthcare Provider Details

I. General information

NPI: 1346671989
Provider Name (Legal Business Name): MANUA HEALTHCARE FOUNDATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6080 CENTER DR FL 6 HOWARD HUGHES CENTER
LOS ANGELES CA
90045-9205
US

IV. Provider business mailing address

8033 W SUNSET BLVD # MS 588
LOS ANGELES CA
90046-2401
US

V. Phone/Fax

Practice location:
  • Phone: 310-853-1230
  • Fax: 310-853-1245
Mailing address:
  • Phone: 323-892-2300
  • Fax: 310-853-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number StateAS
# 3
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateAS
# 5
Primary TaxonomyN
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 8
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateNULL
# 9
Primary TaxonomyN
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. BARNEY SENE
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 310-853-1230