Healthcare Provider Details

I. General information

NPI: 1679063614
Provider Name (Legal Business Name): MANUEL DANIEL MANRIQUE CHAVEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1798 N GAREY AVE
POMONA CA
91767-2918
US

IV. Provider business mailing address

1144 CROWNE DR
PASADENA CA
91107-5924
US

V. Phone/Fax

Practice location:
  • Phone: 909-865-9500
  • Fax:
Mailing address:
  • Phone: 224-428-6073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA174400
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA174400
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: