Provider Demographics
NPI:1417911389
Name:HENRIQUEZ, HUMBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:HUMBERTO
Middle Name:
Last Name:HENRIQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2433 PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-4461
Mailing Address - Country:US
Mailing Address - Phone:757-855-3325
Mailing Address - Fax:757-855-5777
Practice Address - Street 1:2433 PALMETTO ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-4461
Practice Address - Country:US
Practice Address - Phone:757-855-3325
Practice Address - Fax:757-855-5777
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044364207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine