MEDICARE: SANTY ENRIQUEZ

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
1	171W00000X	Contractor

General Provider Information

NPI Number	:	1326506155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANTY ENRIQUEZ

Provider Business Mailing Address
First Line	:	5238 STARKRIDGE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77035-3028
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5238 STARKRIDGE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77035-3028
Country	:	US
Telephone Number	:	713-901-8543
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2019
Last Update Date	:	03/22/2019

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Directions to “ SANTY ENRIQUEZ ” Practice Location

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