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General NPI Number Information
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NPI Number | 1811093131
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Entity Type | Individual
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Provider Name | BERNARDINO ORESTES ENRIQUEZ GENERAL RADIOGRAPHER
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Gender | Male
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 10/26/2009
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Provider Practice Location Address
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Address Line | 4100 S HOSPITAL DR STE 206 PLANTATION
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City | PLANTATION
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State | FL
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Zip | 33317-2837
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Country | US
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Telephone | 954-321-3638
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Fax | 954-321-1422
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Provider Business Mailing Address
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Address Line | 12240 NW 7TH TRL
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City | MIAMI
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State | FL
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Zip | 33182-2408
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Country | US
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Telephone | 305-505-3619
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Fax |
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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 | 2471C3402X
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Taxonomy Name | Radiography Radiologic Technologist
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License Number | 38641
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License Number State | FL
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