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General NPI Number Information
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NPI Number | 1427912013
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Entity Type | Individual
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Provider Name | EULYSES PROFETA MANALO
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Gender | Male
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Dates
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Enumeration Date | 12/10/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 8665 LA MESA BLVD
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City | LA MESA
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State | CA
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Zip | 91942-9503
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Country | US
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Telephone | 619-465-0702
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Fax |
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Provider Business Mailing Address
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Address Line | 9115 CAMBON ST
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City | SPRING VALLEY
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State | CA
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Zip | 91977-5821
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Country | US
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Telephone |
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 95311685
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License Number State | CA
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