Individual
MR. NICHOLAS MANJARREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
159 TROUT AVENUE, NAVAL UNDERSEA MEDICAL INSTITUTE, GROTON, CT 06349-5159
(860) 694-2876
Mailing address
PO BOX 159, GROTON, CT 06349-5159
(860) 694-6453
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
04/20/2017
Last updated
10/25/2023
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