Healthcare Provider Details

I. General information

NPI: 1891297891
Provider Name (Legal Business Name): JENNIFER ENRIQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5180 W ATLANTIC AVE STE 112
DELRAY BEACH FL
33484-8103
US

IV. Provider business mailing address

629 57TH ST
WEST PALM BEACH FL
33407-2513
US

V. Phone/Fax

Practice location:
  • Phone: 561-674-9996
  • Fax:
Mailing address:
  • Phone: 561-317-4029
  • Fax: 954-577-7780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: