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General NPI Number Information
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NPI Number | 1417264177
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Entity Type | Individual
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Provider Name | ROCHELLE ACOBA MANANGKIL D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 09/01/2010
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Last Update Date | 12/22/2021
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Provider Practice Location Address
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Address Line | 3417 BROADWAY ST. STE J-1
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City | AMERICAN CANYON
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State | CA
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Zip | 94503-1262
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Country | US
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Telephone | 707-346-2400
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Fax | 707-346-2401
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Provider Business Mailing Address
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Address Line | 3417 BROADWAY ST STE J1
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City | AMERICAN CANYON
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State | CA
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Zip | 94503-1262
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Country | US
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Telephone | 707-346-2400
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Fax | 707-346-2401
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 59669
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10265
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License Number State | CO
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