Healthcare Provider Details

I. General information

NPI: 1962327296
Provider Name (Legal Business Name): CARLA MANJARREZ MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 NOGALES ST
LA PUENTE CA
91744-6144
US

IV. Provider business mailing address

5529 BELLA WAY
FONTANA CA
92336-5954
US

V. Phone/Fax

Practice location:
  • Phone: 626-965-3437
  • Fax:
Mailing address:
  • Phone: 626-589-8195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number250095831
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: