Provider Demographics
NPI:1255780144
Name:HIPOLITO-MANUEL, JANET
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:HIPOLITO-MANUEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 LEANING OAK DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-6776
Mailing Address - Country:US
Mailing Address - Phone:415-756-5977
Mailing Address - Fax:
Practice Address - Street 1:1918 LEANING OAK DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-6776
Practice Address - Country:US
Practice Address - Phone:415-756-5977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver