Provider Demographics
NPI:1700606597
Name:MANJARREZ, NORMA (LDO)
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:
Last Name:MANJARREZ
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:NORMA
Other - Middle Name:
Other - Last Name:MANJARRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LDO
Mailing Address - Street 1:PO BOX 3814
Mailing Address - Street 2:
Mailing Address - City:SOMERTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85350-3814
Mailing Address - Country:US
Mailing Address - Phone:928-304-8976
Mailing Address - Fax:
Practice Address - Street 1:2900 S PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-3500
Practice Address - Country:US
Practice Address - Phone:928-414-0103
Practice Address - Fax:928-314-0119
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLDO-003042156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician