Provider Demographics
NPI:1053171330
Name:ENRIQUEZ, CARMEN CATHERINE LINTAG
Entity type:Individual
Prefix:
First Name:CARMEN CATHERINE
Middle Name:LINTAG
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 1:6321 SYCAMORE GROVE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-5338
Mailing Address - Country:US
Mailing Address - Phone:702-574-7453
Mailing Address - Fax:
Practice Address - Street 1:6321 SYCAMORE GROVE CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-5338
Practice Address - Country:US
Practice Address - Phone:702-574-7453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator