Individual provider Active NPI

Robert John Manriquez, LCSW

  • Clinical Social Worker
  • Colton, CA
National Provider Identifier
1174620868
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCS 14418 Issued in CA
Practice address
1430 E Cooley Dr Ste 111
Colton, CA 92324-3944
Phone
(909) 825-5128
Fax
(909) 825-8568
NPI assigned
Sep 17, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCS 14418 CA Primary

Addresses

Primary practice location

1430 E Cooley Dr Ste 111
Colton, CA 92324-3944

Mailing address

1430 E Cooley Dr Ste 111
Colton, CA 92324-3944
Phone (909) 825-5128

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101227000617 CA Practitioner - Clinical Social Worker 7113115742 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Inland Psychiatric Medical Group IncGroup PAC ID 9436062312, 119 clinicians

Practice addresses (Care Compare)

8710 Monroe CT
Suite 150
Rancho Cucamonga, CA 91730-4885
Phone (909) 941-4870

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14418CAMDProfessional Counselor
LCS 14418CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Inland Psychiatric Medical Group, Inc. Clinical Current Accepting new patients
Inland Psychiatric Medical Group, Inc. CurrentSince Apr 8, 2019 Accepting new patients

Locations

540 W Baseline Rd
Ste 3
Claremont, CA 91711
Phone (909) 542-0633

8710 Monroe Ct
Ste 150
Rancho Cucamonga, CA 91730
Phone (909) 941-4870

1809 W Redlands Blvd
Redlands, CA 92373
Phone (909) 307-1320

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174620868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 E COOLEY DR STE 111",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923243944",
            "telephone_number": "909-825-5128",
            "fax_number": "909-825-8568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 E COOLEY DR STE 111",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923243944",
            "telephone_number": "909-825-5128",
            "fax_number": "909-825-8568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANRIQUEZ",
        "first_name": "ROBERT",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS 14418",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colton, CA

Sources for this page

Verify at the official NPI Registry.