Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | PA13127 | TX |
NPI | 1578170791 |
---|---|
Provider Name | Theresa Manriquez |
First Address | Austin, TX 78723-3094 |
Second Address | Austin, TX 78746-4945 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2020 |
Last Update Date | 01/10/2020 |