Healthcare Provider Details

I. General information

NPI: 1497253900
Provider Name (Legal Business Name): JENNY LUNA ENRIQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4029 28TH ST SW
LEHIGH ACRES FL
33976-3819
US

IV. Provider business mailing address

4029 28TH ST SW
LEHIGH ACRES FL
33976-3819
US

V. Phone/Fax

Practice location:
  • Phone: 786-445-8305
  • Fax:
Mailing address:
  • Phone: 786-445-8305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number21157398
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: