Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | APN.0990667-NP | CO |
NPI | 1033666458 |
---|---|
Provider Name | Mr. Javier Enriquez |
First Address | Golden, CO 80403-7445 |
Second Address | Golden, CO 80403-7445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2016 |
Last Update Date | 01/09/2016 |