Healthcare Provider Details

I. General information

NPI: 1710048731
Provider Name (Legal Business Name): URIEL ENRIQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6122 WALL ST
ARLINGTON TX
76018
US

IV. Provider business mailing address

6122 WALL ST
ARLINGTON TX
76018
US

V. Phone/Fax

Practice location:
  • Phone: 817-538-1697
  • Fax: 817-557-1384
Mailing address:
  • Phone: 817-538-1697
  • Fax: 817-557-1384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: