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General NPI Number Information
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NPI Number | 1841665411
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Entity Type | Individual
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Provider Name | MICHAEL J MANANSALA MD
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Gender | Male
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Dates
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Enumeration Date | 12/08/2015
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 2999 REGENT ST STE 301
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City | BERKELEY
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State | CA
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Zip | 94705-2118
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Country | US
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Telephone | 510-204-8120
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Fax | 510-506-7723
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Provider Business Mailing Address
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Address Line | 325 DISTEL CIR
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City | LOS ALTOS
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State | CA
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Zip | 94022-1408
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Country | US
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Telephone | 510-204-8120
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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 | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | X
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License Number State | CA
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