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General NPI Number Information
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NPI Number | 1306821590
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Entity Type | Individual
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Provider Name | ALBERT J ENRIQUEZ MD
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Gender | Male
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Dates
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Enumeration Date | 12/09/2005
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Last Update Date | 10/17/2018
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Provider Practice Location Address
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Address Line | 1920 DON WICKHAM DR STE 127
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City | CLERMONT
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State | FL
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Zip | 34711-1978
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Country | US
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Telephone | 352-536-8807
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Fax | 352-536-8819
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Provider Business Mailing Address
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Address Line | 1920 DON WICKHAM DR STE 127
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City | CLERMONT
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State | FL
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Zip | 34711-1978
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Country | US
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Telephone | 352-536-8807
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Fax | 352-536-8819
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number | 32133
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 32133
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number | ME133507
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License Number State | FL
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