Healthcare Provider Details

I. General information

NPI: 1235551003
Provider Name (Legal Business Name): SUZY ENRIQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11901 W PARMER LN SUITE 300
CEDAR PARK TX
78613-7651
US

IV. Provider business mailing address

11901 W PARMER LN SUITE 300
CEDAR PARK TX
78613-7651
US

V. Phone/Fax

Practice location:
  • Phone: 512-652-0050
  • Fax: 512-997-9092
Mailing address:
  • Phone: 512-652-0050
  • Fax: 512-997-9092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: