Basic Information
| Provider Information | |||||||||
| NPI: | 1548444706 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANQUERO | ||||||||
| FirstName: | AMTONIO | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 133 N CHURCH ST FAMLIY BUILDERS | ||||||||
| Address2: | STE 319 | ||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596361775 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 133 N. CHURCH ST. | ||||||||
| Address2: | STE. 319 | ||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596361775 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/24/2007 | ||||||||
| LastUpdateDate: | 12/24/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | CA | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.