MEDICARE: MARIAN GRACE 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95038564	CA

General Provider Information

NPI Number	:	1376478974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAN GRACE ENRIQUEZ

Provider Business Mailing Address
First Line	:	4869 INDEPENDENCE ST
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-1725
Country	:	US
Telephone Number	:	657-255-1515
Fax Number	:

Provider Business Practice Location Address
First Line	:	4869 INDEPENDENCE ST
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-1725
Country	:	US
Telephone Number	:	657-255-1515
Fax Number	:

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

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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