Provider Demographics
NPI:1023281581
Name:MANRIQUEZ, NICOLAS (DPM)
Entity type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:
Last Name:MANRIQUEZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:MANRIQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:24556 KINGSLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-2301
Mailing Address - Country:US
Mailing Address - Phone:281-609-8100
Mailing Address - Fax:281-574-3675
Practice Address - Street 1:24556 KINGSLAND BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-2301
Practice Address - Country:US
Practice Address - Phone:281-609-8100
Practice Address - Fax:281-574-3675
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1861213ES0131X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194299703Medicaid
TX194299704Medicaid
TX194299705Medicaid
TX194299701Medicaid
TX194299702Medicaid
TX5476250001OtherMEDICARE NSC
TX194299701OtherMEDICAID PIN
TX8K7038Medicare PIN
TXTXB154505Medicare PIN
TXTXB154502Medicare PIN
TX194299702Medicaid
TX194299703Medicaid