Provider Demographics
NPI:1669717815
Name:MANRIQUEZ, GUADALUPE HORTENCIA (MD)
Entity type:Individual
Prefix:DR
First Name:GUADALUPE
Middle Name:HORTENCIA
Last Name:MANRIQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 N CALLE SIN ENVIDIA
Mailing Address - Street 2:31
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-1271
Mailing Address - Country:US
Mailing Address - Phone:520-730-7317
Mailing Address - Fax:
Practice Address - Street 1:7601 N CALLE SIN ENVIDIA
Practice Address - Street 2:31
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-1271
Practice Address - Country:US
Practice Address - Phone:520-730-7317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20005207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology