Provider Demographics
NPI:1992820229
Name:HENRIQUEZ, HILDA ELIZABETH (MFC 48258)
Entity type:Individual
Prefix:MS
First Name:HILDA
Middle Name:ELIZABETH
Last Name:HENRIQUEZ
Suffix:
Gender:F
Credentials:MFC 48258
Other - Prefix:MS
Other - First Name:HILDA
Other - Middle Name:ELIZABETH
Other - Last Name:HENRIQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFC 48258
Mailing Address - Street 1:PO BOX 20463
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90801-3463
Mailing Address - Country:US
Mailing Address - Phone:562-787-1178
Mailing Address - Fax:
Practice Address - Street 1:910 E SAN ANTONIO DR
Practice Address - Street 2:#2
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2221
Practice Address - Country:US
Practice Address - Phone:562-787-1178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48258106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist