Provider Demographics
NPI:1477785095
Name:ENRIQUE TECHNOLOGIES INC
Entity Type:Organization
Organization Name:ENRIQUE TECHNOLOGIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ENRIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-626-9244
Mailing Address - Street 1:120 SUNSET HARBOR WAY
Mailing Address - Street 2:NO 201
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-8238
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:777 W DUVAL ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-5806
Practice Address - Country:US
Practice Address - Phone:386-758-6950
Practice Address - Fax:386-758-8018
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENRIQUE TECHNOLOGIES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-14
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health