Healthcare Provider Details

I. General information

NPI: 1215437660
Provider Name (Legal Business Name): STEPHANIE ENRIQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12450 VAN NUYS BLVD STE 200
PACOIMA CA
91331-1393
US

IV. Provider business mailing address

PO BOX 330164
PACOIMA CA
91333-0164
US

V. Phone/Fax

Practice location:
  • Phone: 818-896-1161
  • Fax: 818-896-5069
Mailing address:
  • Phone: 818-270-1140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number133301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: