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General NPI Number Information
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NPI Number | 1952951758
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Entity Type | Individual
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Provider Name | MARICRUZ L MANZANO
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Gender | Female
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Dates
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Enumeration Date | 09/13/2019
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 13001 RAMONA BLVD STE A
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City | IRWINDALE
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State | CA
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Zip | 91706-3752
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Country | US
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Telephone | 626-444-0539
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Fax |
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Provider Business Mailing Address
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Address Line | 940 AVENUE 64
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City | PASADENA
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State | CA
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Zip | 91105-2711
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Country | US
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Telephone | 323-543-2800
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 114756
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT114756
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | AMFT114756
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License Number State | CA
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