Healthcare Provider Details

I. General information

NPI: 1154470136
Provider Name (Legal Business Name): MARIEVIC G MANRIQUE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 08/15/2020
Certification Date: 08/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V ST
SACRAMENTO CA
95817-1460
US

IV. Provider business mailing address

4150 V ST
SACRAMENTO CA
95817-1460
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5028
  • Fax: 916-734-2975
Mailing address:
  • Phone: 916-734-5028
  • Fax: 916-734-2975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA73943
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberA73943
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: