MEDICARE: DR. ANNETTE LOURDES DUMALO ENRIQUEZ M.D, PH.D.

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	207Q00000X	Family Medicine Physician	A90466	CA

General Provider Information

NPI Number	:	1770693863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNETTE LOURDES DUMALO ENRIQUEZ M.D, PH.D.

Provider Business Mailing Address
First Line	:	1221 40TH ST
Second Line	:	APT. 301
City	:	EMERYVILLE
State	:	CA
Zip	:	94608-3665
Country	:	US
Telephone Number	:	510-655-7565
Fax Number	:

Provider Business Practice Location Address
First Line	:	1351 24TH AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-1616
Country	:	US
Telephone Number	:	415-682-1900
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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