Provider Demographics
NPI:1801181433
Name:ENRIQUEZ, DIANA (RPH)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13700 SAN PEDRO AVE
Mailing Address - Street 2:T-0176
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4332
Mailing Address - Country:US
Mailing Address - Phone:210-545-9208
Mailing Address - Fax:210-545-9208
Practice Address - Street 1:13700 SAN PEDRO AVE
Practice Address - Street 2:T-0176
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-4332
Practice Address - Country:US
Practice Address - Phone:210-545-9208
Practice Address - Fax:210-545-9208
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist