Individual
MR. MENA S MANOLLY SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
8845 BARTON ST, RIVERSIDE, CA 92508-3243
(951) 966-7661
Mailing address
8845 BARTON ST, RIVERSIDE, CA 92508-3243
(951) 966-7661
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
CPO03356
CA
224P00000X
Prosthetist
CPO03356
CA
224P00000X
Prosthetist
Primary
—
—
Other
Enumeration date
07/24/2023
Last updated
06/07/2024
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