Provider Demographics
NPI:1992065049
Name:MANALO, RONALD SALAZAR (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:SALAZAR
Last Name:MANALO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 E FLETCHER AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4659
Mailing Address - Country:US
Mailing Address - Phone:813-812-4133
Mailing Address - Fax:813-501-3633
Practice Address - Street 1:3450 E FLETCHER AVE STE 330
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4659
Practice Address - Country:US
Practice Address - Phone:813-812-4133
Practice Address - Fax:813-501-3633
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005432207Q00000X
FLME124461208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist