Individual
MR. RODOLFO PINEDA MANANSALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
INDEPENDENT DUTY HM
Contact information
Practice address
601 D ST BLDG 130-H, GREAT LAKES, IL 60088-2822
(847) 688-3412
Mailing address
950 ELFERING LN, ANTIOCH, IL 60002-6404
(847) 688-3412
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
1710I1002X
CA
Other
Enumeration date
01/09/2008
Last updated
08/27/2009
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