Provider Demographics
NPI:1568280790
Name:MANALANG, ALEX MONTEMAYOR (PCA)
Entity type:Individual
Prefix:MRS
First Name:ALEX
Middle Name:MONTEMAYOR
Last Name:MANALANG
Suffix:
Gender:M
Credentials:PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4245 NOPAL SERRANO AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-9115
Mailing Address - Country:US
Mailing Address - Phone:725-286-7942
Mailing Address - Fax:
Practice Address - Street 1:4850 W FLAMINGO RD STE 25
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3707
Practice Address - Country:US
Practice Address - Phone:702-834-4446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1607932086347C00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No347C00000XTransportation ServicesPrivate Vehicle