Provider Demographics
NPI:1548368384
Name:ENRIQUEZ, JOHN NILA (PSYCHIATRIST MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:NILA
Last Name:ENRIQUEZ
Suffix:
Gender:M
Credentials:PSYCHIATRIST MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:343 W HOUSTON
Mailing Address - Street 2:702
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205
Mailing Address - Country:US
Mailing Address - Phone:210-277-1002
Mailing Address - Fax:210-277-1183
Practice Address - Street 1:343 W HOUSTON
Practice Address - Street 2:702
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205
Practice Address - Country:US
Practice Address - Phone:210-277-1002
Practice Address - Fax:210-277-1183
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH86322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123000504Medicaid
A87530Medicare UPIN
TX123000504Medicaid