Provider Demographics
NPI:1750121752
Name:MANRUBIA, CHRISTIAN OLIVER
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:OLIVER
Last Name:MANRUBIA
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 1:22942 EL TORO RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-4961
Mailing Address - Country:US
Mailing Address - Phone:714-350-7407
Mailing Address - Fax:
Practice Address - Street 1:22942 EL TORO RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4961
Practice Address - Country:US
Practice Address - Phone:714-350-7407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA147956106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist