Provider Demographics
NPI:1699399162
Name:MANRIQUEZ, ENRIQUE
Entity Type:Individual
Prefix:MR
First Name:ENRIQUE
Middle Name:
Last Name:MANRIQUEZ
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 1:821 12TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4462
Mailing Address - Country:US
Mailing Address - Phone:276-790-2667
Mailing Address - Fax:
Practice Address - Street 1:2413 39TH PL NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-1702
Practice Address - Country:US
Practice Address - Phone:276-790-2667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant