Healthcare Provider Details

I. General information

NPI: 1851910517
Provider Name (Legal Business Name): DANIEL OSWALDO MANRIQUE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8803 FUTURES DR STE 12-205
ORLANDO FL
32819-9022
US

IV. Provider business mailing address

2934 CAMDEN WAY
DAVENPORT FL
33837-1730
US

V. Phone/Fax

Practice location:
  • Phone: 407-777-9866
  • Fax: 432-200-4887
Mailing address:
  • Phone: 813-357-4531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number083075
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number21770-875
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberHSE29937
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number164419
License Number StateAK
# 5
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberEL07031
License Number StateNH
# 6
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number30863
License Number StateNH
# 7
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberTPME6512
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: