1023281581 NPI number — DR. NICOLAS MANRIQUEZ DPM

Table of content: DR. NICOLAS MANRIQUEZ DPM (NPI 1023281581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023281581 NPI number — DR. NICOLAS MANRIQUEZ DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANRIQUEZ
Provider First Name:
NICOLAS
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MANRIQUEZ
Provider Other First Name:
NICK
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1023281581
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24556 KINGSLAND BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KATY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77494-2301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-609-8100
Provider Business Mailing Address Fax Number:
281-574-3675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24556 KINGSLAND BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KATY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77494-2301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-609-8100
Provider Business Practice Location Address Fax Number:
281-574-3675
Provider Enumeration Date:
04/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  1861 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 1861 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 194299701 . This is a "MEDICAID PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 194299702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 194299705 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5476250001 . This is a "MEDICARE NSC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 194299703 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 194299701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 194299704 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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