Basic Information
| Provider Information | |||||||||
| NPI: | 1225557747 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ENRIQUEZ | ||||||||
| FirstName: | YVONNE | ||||||||
| MiddleName: | DEJESUS | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 S HIGHLAND SPRINGS AVE | ||||||||
| Address2: | |||||||||
| City: | BANNING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922206504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517976547 | ||||||||
| FaxNumber: | 9517690202 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 S HIGHLAND SPRINGS AVE | ||||||||
| Address2: | |||||||||
| City: | BANNING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922206504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517976547 | ||||||||
| FaxNumber: | 9517690202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WN1003X | 601853 | CA | N | Nursing Service Providers | Registered Nurse | Nutrition Support | 363LF0000X | 95006670 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.