Provider Demographics
NPI:1427662436
Name:MANABAT, DERICK IAN BECIOS
Entity type:Individual
Prefix:
First Name:DERICK IAN
Middle Name:BECIOS
Last Name:MANABAT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DERICK
Other - Middle Name:
Other - Last Name:MANABAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5412 BOULDER HWY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-6039
Mailing Address - Country:US
Mailing Address - Phone:702-291-7121
Mailing Address - Fax:
Practice Address - Street 1:5412 BOULDER HWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-6039
Practice Address - Country:US
Practice Address - Phone:702-291-7121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-07
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator