Individual
MARIETTA E ENRIQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3015 WILSON AVE, LOUISVILLE, KY 40211-1969
(502) 774-4401
Mailing address
3015 WILSON AVE, LOUISVILLE, KY 40211-1969
(502) 774-4401
(502) 772-8983
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
22441
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64224413
—
KY
01
—
K215580
MEDICARE
KY
Enumeration date
01/27/2006
Last updated
06/19/2019
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