Individual
EDGAR ANTONIO ENRIQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
25775 MCBEAN PKWY, SUITE 216, VALENCIA, CA 91355-3708
(661) 253-1353
(661) 253-1387
Mailing address
1401 MONTEREY RD, APT E, SOUTH PASADENA, CA 91030-3845
(310) 435-4450
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
A80489
CA
2086S0127X
Trauma Surgery Physician
A80489
CA
2086X0206X
Surgical Oncology Physician
Primary
A80489
CA
Other
Enumeration date
10/12/2006
Last updated
09/17/2007
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