Provider Demographics
NPI:1497825426
Name:MANRIQUE, ADRIAN A
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:A
Last Name:MANRIQUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16490 HARBOR BLVD
Mailing Address - Street 2:#B
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1375
Mailing Address - Country:US
Mailing Address - Phone:714-418-0828
Mailing Address - Fax:
Practice Address - Street 1:16490 HARBOR BLVD
Practice Address - Street 2:#B
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1375
Practice Address - Country:US
Practice Address - Phone:714-418-0828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health