Provider Demographics
NPI:1528525169
Name:ENRIQUEZ MARIN, ALBERTO M (MA)
Entity type:Individual
Prefix:MR
First Name:ALBERTO
Middle Name:M
Last Name:ENRIQUEZ MARIN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2833 LAKESIDE COMMONS DR APT 103
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-5792
Mailing Address - Country:US
Mailing Address - Phone:813-340-0153
Mailing Address - Fax:
Practice Address - Street 1:10549 N FLORIDA AVE STE G
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-6707
Practice Address - Country:US
Practice Address - Phone:813-399-1625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist