IndividualActive
Rodolfo Manansala, INDEPENDENT DUTY HM
NPI 1184809048 · Independent Duty Corpsman · Great Lakes, IL
Provider details
- NPI number
- 1184809048
- Entity type
- Individual
- Primary specialty
- Independent Duty CorpsmanOther Service Providers
- Credential
- INDEPENDENT DUTY HM
- Sex
- Male
- Sole proprietor
- Yes
- License
- 1710I1002X (CA)
Specialties & taxonomies
Other Service Providers
Practice location
601 D St Bldg 130-H
Great Lakes, IL 60088-2822
Phone: (847) 688-3412
Approximate (ZIP-level) locationGet directions
Mailing address
950 Elfering Ln
Antioch, IL 60002-6404
Registry dates
- Enumerated
- 2008-01-09
- Last updated
- 2009-08-27
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.