Healthcare Provider Details

I. General information

NPI: 1669311809
Provider Name (Legal Business Name): ENRIQUE ANZOLA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 ZONAL AVE STE 115
LOS ANGELES CA
90089-0121
US

IV. Provider business mailing address

2020 ZONAL AVE RM 115
LOS ANGELES CA
90089-0121
US

V. Phone/Fax

Practice location:
  • Phone: 305-776-3416
  • Fax:
Mailing address:
  • Phone: 305-776-3416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: