MEDICARE: NICOLE CARL MANJARREZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		CA

General Provider Information

NPI Number	:	1194361410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE CARL MANJARREZ

Provider Business Mailing Address
First Line	:	60 E CLAY ST
Second Line	:
City	:	COLUSA
State	:	CA
Zip	:	95932-2911
Country	:	US
Telephone Number	:	707-541-8920
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 D ST STE R&S
Second Line	:
City	:	MARYSVILLE
State	:	CA
Zip	:	95901-5952
Country	:	US
Telephone Number	:	530-441-2400
Fax Number	:	530-576-5023

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2019
Last Update Date	:	06/01/2026

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Directions to “ NICOLE CARL MANJARREZ ” Practice Location

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