Provider Demographics
NPI:1801001219
Name:ENRIQUEZ, ANYA (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANYA
Middle Name:
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 75661
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44101-4755
Mailing Address - Country:US
Mailing Address - Phone:330-725-0569
Mailing Address - Fax:
Practice Address - Street 1:5783 WOOSTER PIKE
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-8816
Practice Address - Country:US
Practice Address - Phone:330-725-0569
Practice Address - Fax:330-725-2099
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57007487207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9295262OtherMEDICARE GROUP
OH9295262OtherMEDICARE GROUP
OHEN4216641Medicare PIN