Healthcare Provider Details

I. General information

NPI: 1356848915
Provider Name (Legal Business Name): ENSELE ENTERPRISES CONSULTING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 PARKWAY CALABASAS
CALABASAS CA
91302-1422
US

IV. Provider business mailing address

5030 PARKWAY CALABASAS
CALABASAS CA
91302-1422
US

V. Phone/Fax

Practice location:
  • Phone: 818-914-6924
  • Fax:
Mailing address:
  • Phone: 818-914-6924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MANUEL FUENTES
Title or Position: BILLING DIRECTOR
Credential:
Phone: 818-914-6924