Provider Demographics
NPI:1316126436
Name:MANILDI, CHRISTINA LUELLA (PA)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LUELLA
Last Name:MANILDI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3160 FOLSOM BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5219
Mailing Address - Country:US
Mailing Address - Phone:916-733-5701
Mailing Address - Fax:916-859-1671
Practice Address - Street 1:1667 DOMINICAN WAY
Practice Address - Street 2:SUITE 134
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1518
Practice Address - Country:US
Practice Address - Phone:831-475-8834
Practice Address - Fax:831-475-1014
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA17668363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical