Provider Demographics
NPI:1043435241
Name:MANUSELIS, TAJA ANASTASIA (MD)
Entity type:Individual
Prefix:MRS
First Name:TAJA
Middle Name:ANASTASIA
Last Name:MANUSELIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CRAVEN ROAD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:BERKSHIRE
Mailing Address - Zip Code:RG1 5LE
Mailing Address - Country:GB
Mailing Address - Phone:0118-975-9317
Mailing Address - Fax:
Practice Address - Street 1:1600 EUREKA RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3027
Practice Address - Country:US
Practice Address - Phone:916-817-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74374207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A743740OtherMEDI-CAL PROVIDER NUMBER
CAH42675Medicare UPIN