Individual
BERNARDITA R ENRIQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2750 11TH ST, ROCK ISLAND, IL 61201-5216
(563) 327-2100
(563) 327-2102
Mailing address
500 W RIVER DR, DAVENPORT, IA 52801-1014
(563) 336-3000
(563) 327-2102
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036-066809
IL
208000000X
Pediatrics Physician
34871
IA
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
036-066809
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036066809
—
IL
05
—
0568980
—
IA
05
—
0568998
—
IA
01
—
093469
HEALTH ALLIANCE #
—
01
—
336031012
CONTROLLED SUBSTANCE #
IL
01
—
421060724
BILLING TAX ID# FOR CHC
IA
05
—
421060724005
—
IL
01
—
421606724A5
JOHN DEERE HEALTH
IL
01
—
8122859
ILLINOIS BC/BS
IL
01
—
93612
IOWA BC/BS SEEN IN RI
IA
01
—
IL01A5
JOHN DEERE EDI#
IL
Enumeration date
09/06/2005
Last updated
03/07/2023
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