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General NPI Number Information
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NPI Number | 1932910817
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Entity Type | Individual
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Provider Name | MICHAEL ALLEN MANRIQUEZ
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Gender | Male
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Dates
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Enumeration Date | 01/18/2025
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Last Update Date | 01/18/2025
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Provider Practice Location Address
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Address Line | 1415 E 8TH ST STE 5
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City | NATIONAL CITY
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State | CA
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Zip | 91950-2663
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Country | US
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Telephone | 197-772-7326
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Fax |
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Provider Business Mailing Address
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Address Line | 751 MEDICAL CENTER CT
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City | CHULA VISTA
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State | CA
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Zip | 91911-6617
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Country | US
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Telephone | 619-502-5888
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95033561
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License Number State | CA
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