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General NPI Number Information
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NPI Number | 1699399162
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Entity Type | Individual
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Provider Name | MR. ENRIQUE MANRIQUEZ
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Gender | Male
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Dates
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Enumeration Date | 06/01/2020
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Last Update Date | 08/23/2021
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Provider Practice Location Address
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Address Line | 2413 39TH PL NW
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City | WASHINGTON
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State | DC
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Zip | 20007-1702
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Country | US
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Telephone | 276-790-2667
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Fax |
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Provider Business Mailing Address
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Address Line | 821 12TH ST NE
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City | WASHINGTON
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State | DC
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Zip | 20002-4462
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Country | US
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Telephone | 276-790-2667
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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