Provider Demographics
NPI:1093056947
Name:MANRIQUEZ, ALYNNA A (NP)
Entity Type:Individual
Prefix:
First Name:ALYNNA
Middle Name:A
Last Name:MANRIQUEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 650268
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0268
Mailing Address - Country:US
Mailing Address - Phone:915-532-3770
Mailing Address - Fax:915-313-0487
Practice Address - Street 1:1626 MEDICAL CENTER DR
Practice Address - Street 2:STE 503
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5010
Practice Address - Country:US
Practice Address - Phone:915-532-3770
Practice Address - Fax:915-313-0487
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX751228363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX751228Other751228