Provider Demographics
NPI:1306349907
Name:ENRIQUEZ, ROSE MARIE DELFIN
Entity type:Individual
Prefix:
First Name:ROSE MARIE
Middle Name:DELFIN
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 1:7800 TOPANGA CANYON BLVD APT 221
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-5521
Mailing Address - Country:US
Mailing Address - Phone:818-645-5364
Mailing Address - Fax:
Practice Address - Street 1:7800 TOPANGA CANYON BLVD APT 221
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-5521
Practice Address - Country:US
Practice Address - Phone:818-645-5364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-10
Last Update Date:2018-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA764578163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse