Provider Demographics
NPI:1962244137
Name:MANRIQUE, PATRICIA ELENA (PA)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ELENA
Last Name:MANRIQUE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8930 NW 97TH AVE APT 106
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2590
Mailing Address - Country:US
Mailing Address - Phone:305-607-2734
Mailing Address - Fax:
Practice Address - Street 1:8930 NW 97TH AVE APT 106
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2590
Practice Address - Country:US
Practice Address - Phone:305-607-2734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program