Provider Demographics
NPI:1124072509
Name:MANOLESCU, MICHAEL R (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:MANOLESCU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 GATES AVENUE,
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278
Mailing Address - Country:US
Mailing Address - Phone:213-304-3759
Mailing Address - Fax:
Practice Address - Street 1:555 S 7TH STREET
Practice Address - Street 2:BARSTOW COMMUNITY HOSPITAL
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-1990
Practice Address - Country:US
Practice Address - Phone:760-256-1761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55086207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G550860Medicaid
CA00G55086Medicaid
A93349Medicare UPIN
CA00G55086Medicaid