Provider Demographics
NPI:1609525963
Name:ENRIQUEZ, FAUSTINO (FNP-C)
Entity Type:Individual
Prefix:
First Name:FAUSTINO
Middle Name:
Last Name:ENRIQUEZ
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 BRUNDAGE LN
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304-3248
Mailing Address - Country:US
Mailing Address - Phone:661-323-6086
Mailing Address - Fax:661-324-6301
Practice Address - Street 1:301 BRUNDAGE LN
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-3248
Practice Address - Country:US
Practice Address - Phone:661-323-6086
Practice Address - Fax:661-324-6301
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020266363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily