Provider Demographics
NPI:1427785542
Name:MANRIQUE ULLOA, NANCY MARILIN (AMFT)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:MARILIN
Last Name:MANRIQUE ULLOA
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18221 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-2676
Mailing Address - Country:US
Mailing Address - Phone:213-984-3284
Mailing Address - Fax:
Practice Address - Street 1:18221 E 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-2676
Practice Address - Country:US
Practice Address - Phone:213-984-3284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT158815106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist