Individual
JARED R MANRIQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
25455 BARTON RD STE 204B, LOMA LINDA, CA 92354-3130
(909) 558-6600
Mailing address
FILE # 54701, LOS ANGELES, CA 90074-4701
(909) 651-4300
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
PA65396
CA
Other
Enumeration date
09/03/2024
Last updated
01/02/2025
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