Provider Demographics
NPI:1952199143
Name:ENRIQUEZ, JULIANA ANDREA
Entity type:Individual
Prefix:
First Name:JULIANA
Middle Name:ANDREA
Last Name:ENRIQUEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 ELM ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2246
Mailing Address - Country:US
Mailing Address - Phone:352-283-6321
Mailing Address - Fax:
Practice Address - Street 1:115 THOREAU ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2443
Practice Address - Country:US
Practice Address - Phone:978-371-2792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program