Provider Demographics
NPI:1275994733
Name:MANRIQUEZ, ANNALISHA
Entity Type:Individual
Prefix:
First Name:ANNALISHA
Middle Name:
Last Name:MANRIQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367
Mailing Address - Country:US
Mailing Address - Phone:209-303-6837
Mailing Address - Fax:
Practice Address - Street 1:3725 IOWA AVE
Practice Address - Street 2:
Practice Address - City:RIVERBANK
Practice Address - State:CA
Practice Address - Zip Code:95367-2908
Practice Address - Country:US
Practice Address - Phone:209-303-6837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00844932314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility