Provider Demographics
NPI:1043210016
Name:ENRIQUEZ, JORGE (MD)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:
Last Name:ENRIQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:JORGE
Other - Middle Name:
Other - Last Name:ENRIQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD FACS INC
Mailing Address - Street 1:2021 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3802
Mailing Address - Country:US
Mailing Address - Phone:661-864-7076
Mailing Address - Fax:661-864-7131
Practice Address - Street 1:2021 22ND ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3802
Practice Address - Country:US
Practice Address - Phone:661-864-7076
Practice Address - Fax:661-864-7131
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49936208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A499360Medicaid
CA00A499360Medicaid
CA00A499360Medicare ID - Type Unspecified