Individual
MR. OSWALDO GIOVANNI TAGLE MANRIQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1575 POND RD STE 203, ALLENTOWN, PA 18104-2254
(610) 366-1366
Mailing address
4019 INDIAN CREEK RD, EMMAUS, PA 18049-1909
(610) 704-7694
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA061118
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA061118
MEDICAL PHYSICIAN ASSISTANT LICENSE
PA
01
—
OA005038
OSTEOPATHIC PHYSICIAN ASSISTANT LICENSE
PA
Enumeration date
11/13/2019
Last updated
02/04/2025
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