Mary Grace Alusen Manog

Primary specialty

Case Management Registered NurseTaxonomy code 163WC0400X

License

678363 Issued in CA

Practice address

101 Bodin Cir
Travis AFB, CA 94535-1809

Phone

(707) 423-7310

NPI assigned

Nov 18, 2024

Last updated

Nov 18, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1731888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1538984299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 SAWYER DR",
            "city": "VACAVILLE",
            "state": "CA",
            "postal_code": "956877894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BODIN CIR",
            "city": "TRAVIS AFB",
            "state": "CA",
            "postal_code": "945351809",
            "telephone_number": "707-423-7310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANOG",
        "first_name": "MARY GRACE",
        "middle_name": "ALUSEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-11-18",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "678363",
            "primary": false
        },
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "CA",
            "license": "678363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bryan Malcolm, PA
• Alexander Maldonado, D.D.S
• Sareena Malhi, MD
• Patrick Ryan Maloney, MD
• Unna Camille Coronel Mangune, DPT
• Robert Christopher Marshall, MD
• Ashley Martin, CBD (CBI)
• Margaret Ellen Lopresti Martin, PHARMD
• Daniel Scott Martineau, M.D.
• Martinez Vamc

• Case Management Registered Nurse in Travis AFB, CA
• Providers in Travis AFB, CA by specialty
• Case Management Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.