Healthcare Provider Details

I. General information

NPI: 1831306224
Provider Name (Legal Business Name): MANALOTO AND RACSA MD PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 W PARK ST SUITE 3
PASCO WA
99301-5265
US

IV. Provider business mailing address

527 W PARK ST SUITE 3
PASCO WA
99301-5265
US

V. Phone/Fax

Practice location:
  • Phone: 509-547-0503
  • Fax: 509-547-5815
Mailing address:
  • Phone: 509-547-0503
  • Fax: 509-547-5815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00016945
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD00014929
License Number StateWA

VIII. Authorized Official

Name: DR. GERTRUDES B MANALOTO-RACSA
Title or Position: DOCTOR
Credential: MD
Phone: 509-547-0503