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Organization
MEDIVERSE MEDICAL NETWORK
Active
Organization
MEDIVERSE MEDICAL NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRISTINA ENRIQUEZ (PRESIDENT)
(818) 626-4883
Entity
Organization
Contact information
Practice address
1910 S UNION ST UNIT 1082, ANAHEIM, CA 92805-7430
(818) 626-4883
Mailing address
1910 S UNION ST UNIT 1082, ANAHEIM, CA 92805-7430
(818) 626-4883
Taxonomy
Speciality
Code
Description
License number
State
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
—
NULL
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
—
—
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
261Q00000X
Clinic/Center
—
NULL
Other
Enumeration date
06/28/2022
Last updated
06/28/2022
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