Healthcare Provider Details

I. General information

NPI: 1962561076
Provider Name (Legal Business Name): WALDO N. HENRIQUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 NORTH BRIDGE STREET
VISALIA CA
93291-5014
US

IV. Provider business mailing address

305 EAST CENTER AVE.
VISALIA CA
93291-6331
US

V. Phone/Fax

Practice location:
  • Phone: 559-734-1939
  • Fax: 559-734-4384
Mailing address:
  • Phone: 559-737-4700
  • Fax: 559-737-4782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA95061
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: