Healthcare Provider Details

I. General information

NPI: 1356446959
Provider Name (Legal Business Name): GRETCHEN ENRIQUEZ-FIGUEROA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 AVE. HOSTOS SUITE #7 ASSMCA
MAYAGUEZ PR
00682-1522
US

IV. Provider business mailing address

PO BOX 6613
MAYAGUEZ PR
00681-6613
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-0663
  • Fax: 787-833-1371
Mailing address:
  • Phone: 787-254-3216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number14350
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: