Individual
EMILE MANANSALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
525 N 18TH ST, SUITE 301, PHOENIX, AZ 85006
(602) 252-1510
(602) 256-9488
Mailing address
525 N 18TH ST, SUITE 301, PHOENIX, AZ 85006
(602) 252-1510
(602) 256-9488
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2356
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
555279
ID NUMBER
AZ
Enumeration date
04/18/2006
Last updated
06/20/2016
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