Individual
TINA M ENWALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.P.R.P.
Contact information
Practice address
2677 ZOE AVE STE 304, HUNTINGTON PARK, CA 90255-3699
(323) 346-0960
Mailing address
2677 ZOE AVE STE 304, HUNTINGTON PARK, CA 90255-3699
(323) 346-0960
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
Primary
MPSS-FHADQE
CA
225400000X
Rehabilitation Practitioner
—
—
Other
Enumeration date
09/29/2008
Last updated
09/14/2023
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