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General NPI Number Information
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NPI Number | 1073395265
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Entity Type | Individual
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Provider Name | FELBERT BALANDRA MANINGO RPH
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Gender | Male
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Dates
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Enumeration Date | 10/20/2023
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Last Update Date | 10/20/2023
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Provider Practice Location Address
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Address Line | 33499 YUCAIPA BLVD
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City | YUCAIPA
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State | CA
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Zip | 92399-2064
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Country | US
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Telephone | 909-797-9350
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Fax |
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Provider Business Mailing Address
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Address Line | 263 E KINGMAN ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92410-4845
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Country | US
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Telephone | 909-556-7878
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH88638
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License Number State | CA
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