Healthcare Provider Details

I. General information

NPI: 1306821590
Provider Name (Legal Business Name): ALBERT J ENRIQUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 DON WICKHAM DR STE 127
CLERMONT FL
34711-1978
US

IV. Provider business mailing address

1920 DON WICKHAM DR STE 127
CLERMONT FL
34711-1978
US

V. Phone/Fax

Practice location:
  • Phone: 352-536-8807
  • Fax: 352-536-8819
Mailing address:
  • Phone: 352-536-8807
  • Fax: 352-536-8819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number32133
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number32133
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberME133507
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: