Provider Demographics
NPI:1679337844
Name:ENRIQUEZ, OSCAR RAMON
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:RAMON
Last Name:ENRIQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 APPALOOSA DR STE C310
Mailing Address - Street 2:
Mailing Address - City:SUNLAND PARK
Mailing Address - State:NM
Mailing Address - Zip Code:88063-8904
Mailing Address - Country:US
Mailing Address - Phone:575-332-9086
Mailing Address - Fax:575-332-9132
Practice Address - Street 1:1580 APPALOOSA DR STE C310
Practice Address - Street 2:
Practice Address - City:SUNLAND PARK
Practice Address - State:NM
Practice Address - Zip Code:88063-8904
Practice Address - Country:US
Practice Address - Phone:575-332-9086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM77887363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily