1982616173 NPI number — DR. ANDRES S ENRIQUEZ M.D.

Table of content: DR. ANDRES S ENRIQUEZ M.D. (NPI 1982616173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982616173 NPI number — DR. ANDRES S ENRIQUEZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENRIQUEZ
Provider First Name:
ANDRES
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982616173
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
553 CANYON SPRINGS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-478-2400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
836 E REDD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79912-7221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-833-8444
Provider Business Practice Location Address Fax Number:
915-833-8767
Provider Enumeration Date:
08/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  K7149 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 178232700 . This is a "OWCP DOL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2032372 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: MDK7149 . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 080165782 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: NM009379 . This is a "BLUE CROSS BLUE SHILD NM" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 628635 . This is a "ANTHEM BX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P2139868 . This is a "OXFORD INSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0096ER . This is a "BLUE CROSS BLUE SHILD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8A3420 . This is a "BLUE CROSS BLUE SHILD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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