Provider Demographics
NPI:1669541041
Name:ENRIQUEZ, LINDA B (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:B
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5856 CORPORATE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4754
Mailing Address - Country:US
Mailing Address - Phone:909-881-4522
Mailing Address - Fax:
Practice Address - Street 1:2101 N WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4836
Practice Address - Country:US
Practice Address - Phone:909-881-4522
Practice Address - Fax:909-475-5082
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29487207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A294870Medicaid
CA00A294870Medicaid
CA00A294871Medicare PIN