Provider Demographics
NPI:1174704613
Name:MANRIQUE, ERICKA I
Entity type:Individual
Prefix:
First Name:ERICKA
Middle Name:I
Last Name:MANRIQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 PIVOT POINT WAY
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-1557
Mailing Address - Country:US
Mailing Address - Phone:805-901-7648
Mailing Address - Fax:805-641-9040
Practice Address - Street 1:955 E THOMPSON BLVD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-3008
Practice Address - Country:US
Practice Address - Phone:805-641-9100
Practice Address - Fax:805-641-9040
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)