Individual
JEZEREY MANALO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2414 N BROADWAY STE 201, LOS ANGELES, CA 90031-2359
(323) 644-2000
Mailing address
2414 N BROADWAY STE 201, LOS ANGELES, CA 90031-2359
(323) 644-2000
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT35302
CA
Other
Enumeration date
09/22/2011
Last updated
09/22/2011
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