Provider Demographics
NPI:1285812859
Name:ENRIQUEZ, RODOLFO JR (OPA-C)
Entity type:Individual
Prefix:
First Name:RODOLFO
Middle Name:
Last Name:ENRIQUEZ
Suffix:JR
Gender:M
Credentials:OPA-C
Other - Prefix:
Other - First Name:RUDY
Other - Middle Name:
Other - Last Name:ENRIQUEZ
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:OPA-C
Mailing Address - Street 1:1901 LONG PRAIRIE RD STE 220-80
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4246
Mailing Address - Country:US
Mailing Address - Phone:214-227-2457
Mailing Address - Fax:214-764-0888
Practice Address - Street 1:1901 LONG PRAIRIE RD STE 220-80
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4246
Practice Address - Country:US
Practice Address - Phone:214-227-2457
Practice Address - Fax:214-764-0880
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXOPAC990363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPA-C990OtherNBCOPA