Healthcare Provider Details

I. General information

NPI: 1417900952
Provider Name (Legal Business Name): MARIA MANRIQUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA MANRIQUEZ MD

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 N 12TH ST FL 3
PHOENIX AZ
85006-2837
US

IV. Provider business mailing address

2901 N CENTRAL AVE STE 160
PHOENIX AZ
85012-2702
US

V. Phone/Fax

Practice location:
  • Phone: 602-521-5700
  • Fax: 602-521-5701
Mailing address:
  • Phone: 602-747-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number29090
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberA77827
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA77827
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number29090
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: