Healthcare Provider Details

I. General information

NPI: 1720557408
Provider Name (Legal Business Name): ENRIQUE PRIETO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2018
Last Update Date: 11/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8438 EASTERN AVE
BELL GARDENS CA
90201-6117
US

IV. Provider business mailing address

4309 E 60TH ST
HUNTINGTON PARK CA
90255-3407
US

V. Phone/Fax

Practice location:
  • Phone: 562-927-5453
  • Fax:
Mailing address:
  • Phone: 323-317-4771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number34264
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number34264
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: