Provider Demographics
NPI:1063999431
Name:ROGELIO DRENNING-MANRRIQUEZ
Entity type:Organization
Organization Name:ROGELIO DRENNING-MANRRIQUEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-697-4549
Mailing Address - Street 1:6485 DAY ST STE 201
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-0926
Mailing Address - Country:US
Mailing Address - Phone:951-697-4549
Mailing Address - Fax:
Practice Address - Street 1:6485 DAY ST STE 201
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-0926
Practice Address - Country:US
Practice Address - Phone:951-697-4549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROGELIO DRENNING-MANRRIQUEZ
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55833208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG00055833Medicaid