Provider Demographics
NPI:1225604937
Name:ENRIQUES, MAGDA YANETH
Entity Type:Individual
Prefix:
First Name:MAGDA
Middle Name:YANETH
Last Name:ENRIQUES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 S YELM ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-3258
Mailing Address - Country:US
Mailing Address - Phone:509-378-7297
Mailing Address - Fax:
Practice Address - Street 1:26 S YELM ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3258
Practice Address - Country:US
Practice Address - Phone:509-378-7297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC19136171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter