Provider Demographics
NPI:1568357515
Name:MANCHENO MOLINA, MARICELA DEL CARMEN
Entity type:Individual
Prefix:
First Name:MARICELA
Middle Name:DEL CARMEN
Last Name:MANCHENO MOLINA
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 1:12502 W REDFIELD RD
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335-5925
Mailing Address - Country:US
Mailing Address - Phone:602-476-4217
Mailing Address - Fax:
Practice Address - Street 1:12502 W REDFIELD RD
Practice Address - Street 2:
Practice Address - City:EL MIRAGE
Practice Address - State:AZ
Practice Address - Zip Code:85335-5925
Practice Address - Country:US
Practice Address - Phone:602-476-4217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH20019171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach