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NPI Code Detail

MEDICARE: CHANTEL ENRIQUEZ MA

MEDICARE: CHANTEL ENRIQUEZ MA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1134608045
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHANTEL ENRIQUEZ MA
Provider Business Mailing Address
First Line : 6070 MISSION GORGE RD
Second Line :
City : SAN DIEGO
State : CA
Zip : 92120-4023
Country : US
Telephone Number : 619-961-7734
Fax Number :
Provider Business Practice Location Address
First Line : 6070 MISSION GORGE RD
Second Line :
City : SAN DIEGO
State : CA
Zip : 92120-4023
Country : US
Telephone Number : 619-961-7734
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2018
Last Update Date : 05/13/2019

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