Provider Demographics
NPI:1386516714
Name:MANIWANG, REYOLITO
Entity type:Individual
Prefix:
First Name:REYOLITO
Middle Name:
Last Name:MANIWANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15002 FLATBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-5320
Mailing Address - Country:US
Mailing Address - Phone:714-317-4740
Mailing Address - Fax:
Practice Address - Street 1:6700 WHITE AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-1322
Practice Address - Country:US
Practice Address - Phone:714-317-4740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility