Provider Demographics
NPI:1821246307
Name:URTEAGA, MANUEL (DC)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:
Last Name:URTEAGA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12466 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1005
Mailing Address - Country:US
Mailing Address - Phone:323-788-1414
Mailing Address - Fax:562-789-1995
Practice Address - Street 1:12466 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1005
Practice Address - Country:US
Practice Address - Phone:323-788-1414
Practice Address - Fax:562-789-1995
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31009111N00000X
CA1039149224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
Yes111N00000XChiropractic ProvidersChiropractor