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General NPI Number Information
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NPI Number | 1679859359
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Entity Type | Organization
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Legal Business Name | MANOLITO B. FIDEL, M.D., INC
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Dates
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Enumeration Date | 10/26/2011
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 23700 CAMINO DEL SOL
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City | TORRANCE
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State | CA
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Zip | 90505-5017
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Country | US
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Telephone | 310-530-1151
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Fax | 310-626-9390
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Provider Business Mailing Address
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Address Line | 28919 COVECREST DR
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-4703
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Country | US
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Telephone | 424-400-7748
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Fax | 424-400-7749
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MANOLITO B FIDEL
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Credential | MD
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Telephone | 424-400-7748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A81909
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License Number State | CA
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