Individual
MARIA NELLY GANGAT MANIMBO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
700 S PLYMOUTH PL, ANAHEIM, CA 92806-4531
(714) 457-1085
Mailing address
211 S STATE COLLEGE BLVD, # 418, ANAHEIM, CA 92806-4116
(714) 457-1085
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
MTN01213F
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MTN01213F
—
CA
Enumeration date
02/28/2007
Last updated
07/09/2007
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