Healthcare Provider Details

I. General information

NPI: 1427894401
Provider Name (Legal Business Name): LIZETTE ANGELICA MANRIQUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9727 RICHEON AVE
DOWNEY CA
90240-3132
US

IV. Provider business mailing address

9727 RICHEON AVE
DOWNEY CA
90240-3132
US

V. Phone/Fax

Practice location:
  • Phone: 562-441-4374
  • Fax:
Mailing address:
  • Phone: 562-441-4374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT21957
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: