Provider Demographics
NPI:1104709054
Name:ENRIQUEZ, JOSE (RBT)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:ENRIQUEZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:
Other - Last Name:ENRIQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JOSE ENRIQUEZ
Mailing Address - Street 1:9982 SW 155TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1639
Mailing Address - Country:US
Mailing Address - Phone:786-552-2975
Mailing Address - Fax:305-489-2489
Practice Address - Street 1:9982 SW 155TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-1639
Practice Address - Country:US
Practice Address - Phone:786-552-2975
Practice Address - Fax:305-489-2489
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-29
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1189876106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician