Provider Demographics
NPI:1952517948
Name:ENRIQUEZ, JAYCEE MORALES (IDC)
Entity Type:Individual
Prefix:MR
First Name:JAYCEE
Middle Name:MORALES
Last Name:ENRIQUEZ
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAL SUBMARINE SUPPORT CENTER
Mailing Address - Street 2:9168 SECOND STREET SUITE 202
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23511
Mailing Address - Country:US
Mailing Address - Phone:757-373-1278
Mailing Address - Fax:
Practice Address - Street 1:NAVAL SUBMARINE SUPPORT CENTER
Practice Address - Street 2:9168 SECOND STREET SUITE 202
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23511
Practice Address - Country:US
Practice Address - Phone:757-967-6175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman