Provider Demographics
NPI:1619256732
Name:YZQUIERDO, MANUEL (ATP, CRTS)
Entity Type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:
Last Name:YZQUIERDO
Suffix:
Gender:M
Credentials:ATP, CRTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 RIVER BEND CT
Mailing Address - Street 2:SUITE H
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-5511
Mailing Address - Country:US
Mailing Address - Phone:361-219-5703
Mailing Address - Fax:
Practice Address - Street 1:1305 E NOLANA AVE
Practice Address - Street 2:SUITE H
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6114
Practice Address - Country:US
Practice Address - Phone:956-618-4900
Practice Address - Fax:956-618-1829
Is Sole Proprietor?:No
Enumeration Date:2011-08-07
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILATP5326247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other