Healthcare Provider Details

I. General information

NPI: 1538095708
Provider Name (Legal Business Name): RAE ENRIQUEZ CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAE JEANNE MALLARI ENRIQUEZ CCC-SLP

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 FOREST AVE STE 7
SAN JOSE CA
95128-4805
US

IV. Provider business mailing address

2020 FOREST AVE STE 7
SAN JOSE CA
95128-4805
US

V. Phone/Fax

Practice location:
  • Phone: 408-982-3340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41711
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: