MEDICARE: ANGELIA VALENTINE MANUELITO MSGC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1326860362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELIA VALENTINE MANUELITO MSGC

Provider Business Mailing Address
First Line	:	10800 GOLF COURSE RD NW APT C206
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-6557
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 UNSER BLVD SE STE 28100
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-4741
Country	:	US
Telephone Number	:	505-217-3410
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2024
Last Update Date	:	10/30/2024

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