MEDICARE: AMAYA L MANRIQUEZ

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1457204315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMAYA L MANRIQUEZ

Provider Business Mailing Address
First Line	:	2524 GLENVIEW DR
Second Line	:
City	:	HOLLISTER
State	:	CA
Zip	:	95023-8095
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	256 E HAMILTON AVE STE C
Second Line	:
City	:	CAMPBELL
State	:	CA
Zip	:	95008-0237
Country	:	US
Telephone Number	:	844-322-7483
Fax Number	:

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

Provider Enumeration Date	:	02/19/2026
Last Update Date	:	04/14/2026

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