Provider Demographics
NPI:1851910517
Name:MANRIQUE, DANIEL OSWALDO (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:OSWALDO
Last Name:MANRIQUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2934 CAMDEN WAY
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-1730
Mailing Address - Country:US
Mailing Address - Phone:813-357-4531
Mailing Address - Fax:
Practice Address - Street 1:8803 FUTURES DR STE 12-205
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9022
Practice Address - Country:US
Practice Address - Phone:813-357-4531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK164419207YS0123X
WI21770-875207YS0123X
IN01092543A207YS0123X
NHEL07031207YX0007X
FLHSE29937207YS0123X, 207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck