Healthcare Provider Details

I. General information

NPI: 1649818915
Provider Name (Legal Business Name): MRS. ENALYN ANDRADA LIEBEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6840 LINCOLN AVE
RIVERSIDE CA
92506-4256
US

IV. Provider business mailing address

14288 WILLOW WOOD LN
CHINO HILLS CA
91709-4805
US

V. Phone/Fax

Practice location:
  • Phone: 951-369-9941
  • Fax:
Mailing address:
  • Phone: 909-519-8651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number42352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: