Provider Demographics
NPI:1538701149
Name:ENRIQUEZ, GILLIAN GAIL (MSOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:GILLIAN
Middle Name:GAIL
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:MRS
Other - First Name:GAIL
Other - Middle Name:G
Other - Last Name:ENRIQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSOT, OTR/L
Mailing Address - Street 1:2131 VALLEY RIM GLN
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-3839
Mailing Address - Country:US
Mailing Address - Phone:760-504-2156
Mailing Address - Fax:
Practice Address - Street 1:5651 PALMER WAY STE D
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-7244
Practice Address - Country:US
Practice Address - Phone:760-918-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XP0200X
CA25766225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics