Provider Demographics
NPI:1760155618
Name:HENRIQUEZ, MILAGROS LIZETH
Entity Type:Individual
Prefix:
First Name:MILAGROS
Middle Name:LIZETH
Last Name:HENRIQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1162 E 19TH ST UNIT 1220
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-4232
Mailing Address - Country:US
Mailing Address - Phone:562-443-0491
Mailing Address - Fax:
Practice Address - Street 1:1162 E 19TH ST UNIT 1220
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91784-4232
Practice Address - Country:US
Practice Address - Phone:562-443-0491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider