Provider Demographics
NPI:1518599109
Name:ENRIQUEZ, CZARINA (NP)
Entity Type:Individual
Prefix:MISS
First Name:CZARINA
Middle Name:
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3054 1/2 CLAIREMONT DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6779
Mailing Address - Country:US
Mailing Address - Phone:619-275-1351
Mailing Address - Fax:
Practice Address - Street 1:1965 YOSEMITE AVE STE 250
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-5235
Practice Address - Country:US
Practice Address - Phone:805-583-1070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2018079490363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily