Provider Demographics
NPI:1063653756
Name:HENRIQUEZ, JACQUELINE (OD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:HENRIQUEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:T17 CALLE AZAFRAN
Mailing Address - Street 2:URB. QUINTAS DE DORADO
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4740
Mailing Address - Country:US
Mailing Address - Phone:787-549-8025
Mailing Address - Fax:
Practice Address - Street 1:T17 CALLE AZAFRAN
Practice Address - Street 2:URB. QUINTAS DE DORADO
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4740
Practice Address - Country:US
Practice Address - Phone:787-549-8025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR658152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist