Basic Information
| Provider Information | |||||||||
| NPI: | 1295165504 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENRIQUEZ | ||||||||
| FirstName: | ERIK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1814 FRANKLIN ST FL 4 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946123487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106130330 | ||||||||
| FaxNumber: | 5105694589 | ||||||||
| Practice Location | |||||||||
| Address1: | 3900 VALLEY AVE STE B | ||||||||
| Address2: | |||||||||
| City: | PLEASANTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945664871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106130330 | ||||||||
| FaxNumber: | 5105694589 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2013 | ||||||||
| LastUpdateDate: | 11/22/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 22473 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.