Healthcare Provider Details

I. General information

NPI: 1497116198
Provider Name (Legal Business Name): YADIRA ENRIQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2016
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N RICE AVE
OXNARD CA
93030-7912
US

IV. Provider business mailing address

1901 N RICE AVE STE 170180
OXNARD CA
93030-7912
US

V. Phone/Fax

Practice location:
  • Phone: 805-485-7000
  • Fax:
Mailing address:
  • Phone: 805-485-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: