Provider Demographics
NPI:1811093131
Name:ENRIQUEZ, BERNARDINO ORESTES (GENERAL RADIOGRAPHER)
Entity type:Individual
Prefix:
First Name:BERNARDINO
Middle Name:ORESTES
Last Name:ENRIQUEZ
Suffix:
Gender:M
Credentials:GENERAL RADIOGRAPHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12240 NW 7TH TRL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-2408
Mailing Address - Country:US
Mailing Address - Phone:305-505-3619
Mailing Address - Fax:
Practice Address - Street 1:4100 S HOSPITAL DR STE 206
Practice Address - Street 2:PLANTATION
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2837
Practice Address - Country:US
Practice Address - Phone:954-321-3638
Practice Address - Fax:954-321-1422
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL386412471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography