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General NPI Number Information
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NPI Number | 1396550539
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Entity Type | Individual
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Provider Name | RANCE KENDREICK MANALO
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Gender | Male
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 560 N CAMINO MERCADO STE 7
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City | CASA GRANDE
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State | AZ
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Zip | 85122-5759
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Country | US
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Telephone | 520-836-5538
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Fax | 844-722-0049
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Provider Business Mailing Address
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Address Line | 560 N CAMINO MERCARDO SUITE 7
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City | CASA GRANDE
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State | AZ
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Zip | 85122-5759
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Country | US
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Telephone | 520-836-5538
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Fax | 844-722-0049
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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 | 163WN0300X
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Taxonomy Name | Nephrology Registered Nurse
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License Number | 197505
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 322036
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License Number State | AZ
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