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General NPI Number Information
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NPI Number | 1407923055
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Entity Type | Individual
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Provider Name | KATHERINE ANN MANALO O.D.
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Gender | Female
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 951 EL CAMINO REAL
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City | SOUTH SAN FRANCISCO
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State | CA
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Zip | 94080-3203
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Country | US
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Telephone | 650-244-9744
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Fax | 888-663-9146
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Provider Business Mailing Address
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Address Line | 2442 DAWN WAY
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City | FAIRFIELD
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State | CA
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Zip | 94533-1674
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Country | US
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Telephone | 415-378-0387
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 13124T
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 7481T
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License Number State | TX
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