Basic Information
| Provider Information | |||||||||
| NPI: | 1134215049 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANALO | ||||||||
| FirstName: | MITCHELLE | ||||||||
| MiddleName: | OLILA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 675 XANADU WAY | ||||||||
| Address2: | |||||||||
| City: | OXNARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930365508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8557017955 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 S. HILLS RD | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CALIFORNIA | ||||||||
| PostalCode: | 93003 | ||||||||
| CountryCode: | UM | ||||||||
| TelephoneNumber: | 8557017955 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 12/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0809X | 494350 | CA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult |
No ID Information.