Provider Demographics
NPI:1336969104
Name:MANUEL, DREONA GENESE (PUBLIC HEALTH ADMIN)
Entity type:Individual
Prefix:
First Name:DREONA
Middle Name:GENESE
Last Name:MANUEL
Suffix:
Gender:F
Credentials:PUBLIC HEALTH ADMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30431 TIN MINE ST
Mailing Address - Street 2:
Mailing Address - City:HOMELAND
Mailing Address - State:CA
Mailing Address - Zip Code:92548-3283
Mailing Address - Country:US
Mailing Address - Phone:951-462-3014
Mailing Address - Fax:
Practice Address - Street 1:30431 TIN MINE ST
Practice Address - Street 2:
Practice Address - City:HOMELAND
Practice Address - State:CA
Practice Address - Zip Code:92548-3283
Practice Address - Country:US
Practice Address - Phone:951-462-3014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6070911735172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker