Healthcare Provider Details

I. General information

NPI: 1003737099
Provider Name (Legal Business Name): ENRIQUE CEJA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11850 PIERCE ST STE 200
RIVERSIDE CA
92505-5184
US

IV. Provider business mailing address

11850 PIERCE ST STE 200
RIVERSIDE CA
92505-5184
US

V. Phone/Fax

Practice location:
  • Phone: 951-465-3664
  • Fax:
Mailing address:
  • Phone: 951-465-3664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: