Individual
NICOLE JEAN ENQUIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMT
Contact information
Practice address
400 CARLTON AVE STE 6, LOS GATOS, CA 95032-2629
(408) 355-3507
Mailing address
710 NIDO DR APT 62, CAMPBELL, CA 95008-4843
(408) 355-3507
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
28347
CA
Other
Enumeration date
06/08/2017
Last updated
06/08/2017
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