MEDICARE: MARIA 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	9525	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831348986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA ENRIQUEZ

Provider Business Mailing Address
First Line	:	226 W LINCOLN ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85714-1422
Country	:	US
Telephone Number	:	520-620-1055
Fax Number	:	520-750-0056

Provider Business Practice Location Address
First Line	:	226 W LINCOLN ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85714-1422
Country	:	US
Telephone Number	:	520-620-1055
Fax Number	:	520-750-0056

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

Provider Enumeration Date	:	09/13/2008
Last Update Date	:	09/13/2008

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Directions to “ MARIA ENRIQUEZ ” Practice Location

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