Individual
DANIEL MANRIQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
412 PASEO FLAMENCO, RIO RICO, AZ 85648-6515
(520) 604-5980
Mailing address
PO BOX 86537, TUCSON, AZ 85754-6537
(520) 721-1887
(520) 407-5398
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
11402661
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11402611
THERAPEUTIC FOSTER CARE
AZ
Enumeration date
07/18/2022
Last updated
07/18/2022
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