Provider Demographics
NPI:1861114241
Name:ENRIQUEZ, TINA
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11914 DRAGON LANE
Mailing Address - Street 2:SPECIAL EDUCATION OFFICE
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78252
Mailing Address - Country:US
Mailing Address - Phone:210-622-4300
Mailing Address - Fax:
Practice Address - Street 1:11535 PEARSALL RD
Practice Address - Street 2:ELM CREEK ELEMENTARY
Practice Address - City:ATASCOSA
Practice Address - State:TX
Practice Address - Zip Code:78002
Practice Address - Country:US
Practice Address - Phone:210-622-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist