Healthcare Provider Details

I. General information

NPI: 1720058415
Provider Name (Legal Business Name): SUZANNE ELLEN ENLOE-WHITAKER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUZANNE ELLEN ENLOE DO

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 11/16/2025
Certification Date: 11/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 NORTH WATERMAN AVE
SAN BERNARDINO CA
92404-5105
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 909-883-8611
  • Fax: 909-886-1798
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number20A7535
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: