Provider Demographics
NPI:1548444706
Name:MANQUERO, AMTONIO F
Entity type:Individual
Prefix:MR
First Name:AMTONIO
Middle Name:F
Last Name:MANQUERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 N CHURCH ST FAMLIY BUILDERS
Mailing Address - Street 2:STE 319
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291
Mailing Address - Country:US
Mailing Address - Phone:559-636-1775
Mailing Address - Fax:
Practice Address - Street 1:133 N. CHURCH ST.
Practice Address - Street 2:STE. 319
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291
Practice Address - Country:US
Practice Address - Phone:559-636-1775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor