Provider Demographics
NPI:1063115921
Name:MANALO, JAZELLE ANN
Entity type:Individual
Prefix:MISS
First Name:JAZELLE
Middle Name:ANN
Last Name:MANALO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E ESPLANADE DR STE 600
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0525
Mailing Address - Country:US
Mailing Address - Phone:805-981-2883
Mailing Address - Fax:877-306-6792
Practice Address - Street 1:500 E ESPLANADE DR STE 600
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0525
Practice Address - Country:US
Practice Address - Phone:805-981-2883
Practice Address - Fax:877-306-6792
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA728318164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse