Provider Demographics
NPI:1699748780
Name:HENRIQUEZ, APOLINAR ADALBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:APOLINAR
Middle Name:ADALBERTO
Last Name:HENRIQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 RIVER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2905
Mailing Address - Country:US
Mailing Address - Phone:321-537-2612
Mailing Address - Fax:
Practice Address - Street 1:71 RIVER RIDGE DR
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2905
Practice Address - Country:US
Practice Address - Phone:321-537-2612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0042863207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51253ZMedicare ID - Type UnspecifiedPROVIDER NUMBER