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General NPI Number Information
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NPI Number | 1952395972
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Entity Type | Individual
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Provider Name | BERNARDITA R ENRIQUEZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/06/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2750 11TH ST
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City | ROCK ISLAND
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State | IL
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Zip | 61201-5216
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Country | US
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Telephone | 563-327-2100
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Fax | 563-327-2102
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Provider Business Mailing Address
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Address Line | 500 W RIVER DR
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City | DAVENPORT
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State | IA
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Zip | 52801-1014
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Country | US
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Telephone | 563-336-3000
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Fax | 563-327-2102
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036-066809
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 34871
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | 036-066809
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License Number State | IL
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