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Individual

MR. CONRADO VILLASENOR MANIMBO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1325 N. RED GUM ST., SUITE 14, ANAHEIM, CA 92806
(714) 238-9005
(714) 238-9085
Mailing address
1325 N. RED GUM ST., SUITE 14, ANAHEIM, CA 92806
(714) 238-9005
(714) 238-9085

Taxonomy

Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
MTN01213F
CA
Enumeration date
11/03/2011
Last updated
11/03/2011
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