Provider Demographics
NPI:1376909317
Name:MANJARREZ, DAMARIS (LMP)
Entity Type:Individual
Prefix:
First Name:DAMARIS
Middle Name:
Last Name:MANJARREZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 TIETON DR
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3691
Mailing Address - Country:US
Mailing Address - Phone:509-966-3421
Mailing Address - Fax:509-972-0980
Practice Address - Street 1:3808 TIETON DR
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3691
Practice Address - Country:US
Practice Address - Phone:509-966-3421
Practice Address - Fax:509-972-0980
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60604079225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist