Healthcare Provider Details

I. General information

NPI: 1336076512
Provider Name (Legal Business Name): ALEXA MANRRIQUEZ MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N AVENUE 64
LOS ANGELES CA
90042-2138
US

IV. Provider business mailing address

707 N AVENUE 64
LOS ANGELES CA
90042-2138
US

V. Phone/Fax

Practice location:
  • Phone: 714-824-0867
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEXA NOELLE MANRRIQUEZ
Title or Position: CEO
Credential: MD
Phone: 714-824-0867