Basic Information
| Provider Information | |||||||||
| NPI: | 1093042608 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANRIQUEZ-JIMENEZ | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | ELENA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MANRIQUEZ | ||||||||
| OtherFirstName: | LESLIE | ||||||||
| OtherMiddleName: | ELENA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1424 30TH ST STE A | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921543417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195652650 | ||||||||
| FaxNumber: | 6195652656 | ||||||||
| Practice Location | |||||||||
| Address1: | 1105 BROADWAY STE 207 | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919112767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194255609 | ||||||||
| FaxNumber: | 6194258349 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2009 | ||||||||
| LastUpdateDate: | 11/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 109278 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.