Active NPI
Maria Manjarrez
- Community Health Worker
- Gresham, OR
National Provider Identifier
1841062999
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- THW107058
- Practice address
- 268 SW Lillyben Ave
Gresham, OR 97080-8401 - Phone
- (503) 380-6752
- NPI assigned
- Oct 23, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutrition Education Nutritionist | 133NN1002X | OR | ||
| Community Health Worker | 172V00000X | THW107058 | OR | Primary |
Addresses
Primary practice location
268 SW Lillyben Ave
Gresham, OR 97080-8401
Mailing address
268 SW Lillyben Ave
Gresham, OR 97080-8401
Phone (503) 380-6752
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| THW107058 | OR | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1698019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698019200000",
"number": "1841062999",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "268 SW LILLYBEN AVE",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970808401",
"telephone_number": "503-380-6752"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "268 SW LILLYBEN AVE",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970808401",
"telephone_number": "503-380-6752"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANJARREZ",
"first_name": "MARIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-10-23",
"last_updated": "2023-10-23",
"certification_date": "2023-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "133NN1002X",
"taxonomy_group": "",
"desc": "Nutritionist, Nutrition, Education",
"state": "OR",
"license": null,
"primary": false
},
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "OR",
"license": "THW107058",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gresham, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.