Provider Demographics
NPI:1710664339
Name:ELGUERA, MANUEL MARTIN
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:MARTIN
Last Name:ELGUERA
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 1:1521 BLAKE ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-1805
Mailing Address - Country:US
Mailing Address - Phone:619-715-1237
Mailing Address - Fax:
Practice Address - Street 1:1521 BLAKE ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-1805
Practice Address - Country:US
Practice Address - Phone:619-715-1237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator