Provider Demographics
NPI:1477911709
Name:MANRIQUEZ, DAWN ROSE-MARIE (NP-C)
Entity type:Individual
Prefix:
First Name:DAWN ROSE-MARIE
Middle Name:
Last Name:MANRIQUEZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:DAWN ROSE-MARIE
Other - Middle Name:
Other - Last Name:BYNUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17660 LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-6410
Mailing Address - Country:US
Mailing Address - Phone:562-933-0400
Mailing Address - Fax:
Practice Address - Street 1:17660 LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-6410
Practice Address - Country:US
Practice Address - Phone:562-933-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003784363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily