Healthcare Provider Details

I. General information

NPI: 1912104472
Provider Name (Legal Business Name): GABRIEL ENESCU PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W KETTLEMAN LN
LODI CA
95242-4334
US

IV. Provider business mailing address

2000 W KETTLEMAN LN
LODI CA
95242-4334
US

V. Phone/Fax

Practice location:
  • Phone: 916-716-2034
  • Fax:
Mailing address:
  • Phone: 916-716-2034
  • Fax: 209-370-9095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number34617
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License Number34617
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number34617
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number34617
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number34617
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number34617
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number34617
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: