Basic Information
| Provider Information | |||||||||
| NPI: | 1568406114 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENRIQUEZ | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6430 W SUNSET BLVD | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900287900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233612337 | ||||||||
| FaxNumber: | 3233618491 | ||||||||
| Practice Location | |||||||||
| Address1: | 4650 W SUNSET BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900276062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233612450 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 08/18/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | G87219 | CA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | C10008527 | DE | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP3000X | C10008527 | DE | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0146021 | 05 | NJ | MEDICAID | 102064037 | 05 | PA | MEDICAID | 00G872190 | 05 | CA | MEDICAID | 00G872190 | 01 | CA | BLUE SHIELD OF CA | OTHER | 100508332 | 05 | NV | MEDICAID | 4136501 | 05 | MD | MEDICAID |