Individual
JENSEN DOMINGO MANABAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RADIOLOGIC TECHNOLOG
Contact information
Practice address
550 SAINT CHARLES DR, THOUSAND OAKS, CA 91360-3951
(805) 579-0288
Mailing address
2826 RACINE ST, SIMI VALLEY, CA 93065-2730
(805) 815-9057
(805) 842-1772
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
RHF00085813
CA
Other
Enumeration date
06/21/2017
Last updated
06/21/2017
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