Provider Demographics
NPI:1770031304
Name:BOHORQUEZ, MANUEL JR
Entity Type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:
Last Name:BOHORQUEZ
Suffix:JR
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 1:212 I ST
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4213
Mailing Address - Country:US
Mailing Address - Phone:530-758-4078
Mailing Address - Fax:
Practice Address - Street 1:212 I ST
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4213
Practice Address - Country:US
Practice Address - Phone:530-758-4078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health