Provider Demographics
NPI:1548385578
Name:ENRIQUEZ, CARLA VICTORIA (MD, FAAP)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:VICTORIA
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1138 E CHESTNUT AVE
Mailing Address - Street 2:BLDG. 1, STE. C
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-5053
Mailing Address - Country:US
Mailing Address - Phone:856-691-8426
Mailing Address - Fax:856-696-7053
Practice Address - Street 1:1138 E CHESTNUT AVE
Practice Address - Street 2:BLDG. 1, STE. C
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-5053
Practice Address - Country:US
Practice Address - Phone:856-691-8426
Practice Address - Fax:856-696-7053
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25MA02657600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist