Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 32133 | MN |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | ME133507 | FL |
N | 207VG0400X | Gynecologist | 32133 | MN |
NPI | 1306821590 |
---|---|
Provider Name | Dr. Albert J Enriquez |
First Address | Clermont, FL 34711-1978 |
Second Address | Clermont, FL 34711-1978 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2005 |
Last Update Date | 17/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
023047800 | (05) | FL |
P00914343 | RR MEDICARE (01) | MN |