Provider Demographics
NPI:1144564436
Name:ENRIQUEZ, CHRISTOPHER GADDI (DPM)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:GADDI
Last Name:ENRIQUEZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 N ABEL ST
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-4833
Mailing Address - Country:US
Mailing Address - Phone:408-262-1188
Mailing Address - Fax:408-599-3182
Practice Address - Street 1:14 N ABEL ST
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-4833
Practice Address - Country:US
Practice Address - Phone:408-262-1188
Practice Address - Fax:408-599-3182
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAE5138213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program