Provider Demographics
NPI:1245017342
Name:HENRIQUEZ, ALLAN STEVEN
Entity type:Individual
Prefix:
First Name:ALLAN
Middle Name:STEVEN
Last Name:HENRIQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23220 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2633
Mailing Address - Country:US
Mailing Address - Phone:661-430-9360
Mailing Address - Fax:
Practice Address - Street 1:23220 LYONS AVE
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2633
Practice Address - Country:US
Practice Address - Phone:661-430-9360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker