Provider Demographics
NPI:1225557747
Name:ENRIQUEZ, YVONNE DEJESUS (NP)
Entity Type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:DEJESUS
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 S HIGHLAND SPRINGS AVE
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-6504
Mailing Address - Country:US
Mailing Address - Phone:951-797-6547
Mailing Address - Fax:951-769-0202
Practice Address - Street 1:300 S HIGHLAND SPRINGS AVE
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-6504
Practice Address - Country:US
Practice Address - Phone:951-797-6547
Practice Address - Fax:951-769-0202
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA601853163WN1003X
CA95006670363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support