Provider Demographics
NPI:1346878832
Name:MANRIQUE, ANGELICA HERNANDEZ
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:HERNANDEZ
Last Name:MANRIQUE
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 1:5350 MACHADO LN
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-8800
Mailing Address - Country:US
Mailing Address - Phone:310-737-9393
Mailing Address - Fax:310-313-0178
Practice Address - Street 1:5350 MACHADO LN
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90230-8800
Practice Address - Country:US
Practice Address - Phone:310-737-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program