Provider Demographics
NPI:1659834802
Name:MANJARREZ, JORGE EMMANUEL
Entity type:Individual
Prefix:MR
First Name:JORGE
Middle Name:EMMANUEL
Last Name:MANJARREZ
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 1:41760 IVY ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-9408
Mailing Address - Country:US
Mailing Address - Phone:951-595-4673
Mailing Address - Fax:951-595-4301
Practice Address - Street 1:41760 IVY ST STE 101
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9408
Practice Address - Country:US
Practice Address - Phone:951-595-4673
Practice Address - Fax:951-595-4301
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician