Provider Demographics
NPI:1295165504
Name:ENRIQUEZ, ERIK
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:
Last Name:ENRIQUEZ
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 1:1814 FRANKLIN ST FL 4
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3487
Mailing Address - Country:US
Mailing Address - Phone:510-613-0330
Mailing Address - Fax:510-569-4589
Practice Address - Street 1:3900 VALLEY AVE STE B
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4871
Practice Address - Country:US
Practice Address - Phone:510-613-0330
Practice Address - Fax:510-569-4589
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22473101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health