Provider Demographics
NPI:1093049702
Name:HERCULEAN BABIES PEDIATRICS
Entity Type:Organization
Organization Name:HERCULEAN BABIES PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:PEDRO
Authorized Official - Last Name:ENZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-964-9647
Mailing Address - Street 1:500 ALFRED NOBEL DR STE 255A
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1843
Mailing Address - Country:US
Mailing Address - Phone:510-964-9647
Mailing Address - Fax:
Practice Address - Street 1:500 ALFRED NOBEL DR STE 255A
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1843
Practice Address - Country:US
Practice Address - Phone:510-964-9647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG051091261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF09908Medicare UPIN