Healthcare Provider Details

I. General information

NPI: 1992639116
Provider Name (Legal Business Name): ANGELA CATALINA MANJARREZ LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 2ND ST
SAN RAFAEL CA
94901-2712
US

IV. Provider business mailing address

829 POMONA AVE
EL CERRITO CA
94530-2946
US

V. Phone/Fax

Practice location:
  • Phone: 415-492-4444
  • Fax:
Mailing address:
  • Phone: 415-492-4444
  • Fax: 415-492-8844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number760985
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: