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General NPI Number Information
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NPI Number | 1891195210
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Entity Type | Organization
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Legal Business Name | THERESA ENRIQUEZ, MD, INC
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Dates
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Enumeration Date | 09/04/2014
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Last Update Date | 09/04/2014
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Provider Practice Location Address
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Address Line | 210 W 7TH ST
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City | OXNARD
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State | CA
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Zip | 93030-7173
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Country | US
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Telephone | 805-394-0898
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Fax | 805-394-0897
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Provider Business Mailing Address
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Address Line | 210 W 7TH ST
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City | OXNARD
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State | CA
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Zip | 93030-7173
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Country | US
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Telephone | 805-394-0898
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Fax | 805-394-0897
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Authorized Official
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Title or Position | PRESIDENT
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Name | THERESA ENRIQUEZ
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Credential | M.D.
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Telephone | 805-394-0898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | G49327
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License Number State | CA
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