Provider Demographics
NPI:1477152163
Name:ENRIQUEZ, CHRISTOPHER G
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:G
Last Name:ENRIQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 WHITE LN APT 25
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-7768
Mailing Address - Country:US
Mailing Address - Phone:661-886-4920
Mailing Address - Fax:
Practice Address - Street 1:4550 PANAMA LN STE 100
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-3486
Practice Address - Country:US
Practice Address - Phone:661-631-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019049363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner