Provider Demographics
NPI:1427865641
Name:PADAMADA, GEOSTRAUSS MANALO
Entity type:Individual
Prefix:
First Name:GEOSTRAUSS
Middle Name:MANALO
Last Name:PADAMADA
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 1:7927 PRAIRIE ROSE WAY
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-5772
Mailing Address - Country:US
Mailing Address - Phone:310-844-2764
Mailing Address - Fax:
Practice Address - Street 1:7927 PRAIRIE ROSE WAY
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-5772
Practice Address - Country:US
Practice Address - Phone:310-844-2764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC20222171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist