Provider Demographics
NPI:1558584334
Name:ENRICO, VIRGINIA H (PHD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:H
Last Name:ENRICO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:HUNT JOHNSON
Other - Last Name:ENRICO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:11137 NILE RIVER CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-2941
Mailing Address - Country:US
Mailing Address - Phone:916-631-8400
Mailing Address - Fax:916-631-8400
Practice Address - Street 1:11137 NILE RIVER CT
Practice Address - Street 2:SUITE 100
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-2941
Practice Address - Country:US
Practice Address - Phone:916-631-8400
Practice Address - Fax:916-631-8400
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19630103TC0700X
TX24121103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000T44L6Medicaid
TX00T24LMedicare ID - Type Unspecified