Provider Demographics
NPI:1811710056
Name:ENRIQUEZ, YESENIA ESMERALDA
Entity type:Individual
Prefix:
First Name:YESENIA
Middle Name:ESMERALDA
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 N SMITH ST
Mailing Address - Street 2:
Mailing Address - City:WEST CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-1445
Mailing Address - Country:US
Mailing Address - Phone:937-475-5348
Mailing Address - Fax:
Practice Address - Street 1:132 N SMITH ST
Practice Address - Street 2:
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-1445
Practice Address - Country:US
Practice Address - Phone:937-475-5348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide