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General NPI Number Information
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NPI Number | 1336730571
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Entity Type | Individual
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Provider Name | MARY CAROLINE E. MACAM MANALO NP
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Gender | Female
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Dates
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Enumeration Date | 01/31/2021
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Last Update Date | 01/31/2021
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Provider Practice Location Address
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Address Line | 701 PLEASANT GROVE BLVD #125
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City | ROSEVILLE
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State | CA
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Zip | 95678
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Country | US
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Telephone | 916-784-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 6511 NEBULA CT
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City | ROCKLIN
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State | CA
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Zip | 95677
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Country | US
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Telephone | 951-756-3618
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | NP95016452
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License Number State | CA
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