# MEDIVERSE MEDICAL NETWORK

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487386488
- **Authorized official:** CRISTINA ENRIQUEZ (PRESIDENT)
- **Authorized official phone:** (818) 626-4883

## Contact information

- **Practice address:** 1910 S UNION ST UNIT 1082, ANAHEIM, CA 92805-7430
- **Practice address phone:** (818) 626-4883
- **Mailing address:** 1910 S UNION ST UNIT 1082, ANAHEIM, CA 92805-7430
- **Mailing address phone:** (818) 626-4883

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084B0040X | Behavioral Neurology & Neuropsychiatry Physician | — | NULL | — |
| 2084B0040X | Behavioral Neurology & Neuropsychiatry Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 261Q00000X | Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 06/28/2022
- **Last updated:** 06/28/2022