Provider Demographics
NPI:1710757216
Name:MANRESA, MARIETA
Entity Type:Individual
Prefix:
First Name:MARIETA
Middle Name:
Last Name:MANRESA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 SW 89TH AVE APT 401
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-5469
Mailing Address - Country:US
Mailing Address - Phone:786-354-3505
Mailing Address - Fax:
Practice Address - Street 1:306 ALCAZAR AVE STE 205
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4331
Practice Address - Country:US
Practice Address - Phone:305-967-8725
Practice Address - Fax:305-967-8446
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician