Provider Demographics
NPI:1891810438
Name:ENRIQUEZ, AURELIO JR (LCSW, PSYD)
Entity Type:Individual
Prefix:DR
First Name:AURELIO
Middle Name:
Last Name:ENRIQUEZ
Suffix:JR
Gender:M
Credentials:LCSW, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 BASELINE RD STE 108
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-5827
Mailing Address - Country:US
Mailing Address - Phone:909-980-1000
Mailing Address - Fax:866-880-1254
Practice Address - Street 1:9330 BASELINE RD STE 108
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-5827
Practice Address - Country:US
Practice Address - Phone:909-980-1000
Practice Address - Fax:866-880-1254
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 248621041C0700X
CAPSY-29785103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty