MEDICARE: DENNIS MANALOTO ESELLER

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1689214181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS MANALOTO ESELLER

Provider Business Mailing Address
First Line	:	1691 MELROSE AVE UNIT K
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91911-5966
Country	:	US
Telephone Number	:	619-392-2532
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 EAST 7TH STREET, NATIONAL CITY, CA 91950
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-9195
Country	:	US
Telephone Number	:	619-232-9343
Fax Number	:

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

Provider Enumeration Date	:	01/13/2020
Last Update Date	:	01/13/2020

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Directions to “ DENNIS MANALOTO ESELLER ” Practice Location

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