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General NPI Number Information
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NPI Number | 1740580703
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Entity Type | Organization
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Legal Business Name | EDGAR ENRIQUEZ, MD INC.
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Dates
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Enumeration Date | 10/25/2010
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Last Update Date | 10/25/2010
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Provider Practice Location Address
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Address Line | 27420 TOURNEY RD SUITE 210
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City | VALENCIA
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State | CA
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Zip | 91355-5601
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Country | US
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Telephone | 661-253-1353
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Fax | 661-253-1387
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Provider Business Mailing Address
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Address Line | PO BOX 367
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City | SOUTH PASADENA
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State | CA
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Zip | 91031-0367
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Country | US
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Telephone | 661-253-1353
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Fax | 661-253-1387
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDGAR ANTONIO ENRIQUEZ
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Credential | M.D.
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Telephone | 310-435-4450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A80489
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License Number State | CA
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