Healthcare Provider Details

I. General information

NPI: 1306732037
Provider Name (Legal Business Name): ROBERT RAYMOND ENFIELD JR. CHW0000000652
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2428 E APACHE BLVD STE 123
TEMPE AZ
85288-2382
US

IV. Provider business mailing address

2428 E APACHE BLVD STE 123
TEMPE AZ
85288-2382
US

V. Phone/Fax

Practice location:
  • Phone: 602-361-4805
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberCHW0000000652
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: