Marietta E Enriquez, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

22441 Issued in KY

Practice address

3015 Wilson Ave
Louisville, KY 40211-1969

Phone

(502) 774-4401

NPI assigned

Jan 27, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Interoperability endpoints

• Direct secure messaging: marietta.enriquez.1@27238.direct.athenahealth.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560902400000",
    "number": "1124099353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3015 WILSON AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402111969",
            "telephone_number": "502-774-4401",
            "fax_number": "502-772-8983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3015 WILSON AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402111969",
            "telephone_number": "502-774-4401"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "305 W Broadway",
            "address_2": "Suite 104",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402022129",
            "country_code": "US",
            "telephone_number": "502-585-2924 x116",
            "fax_number": "502-585-2931",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "305 W Broadway",
            "address_2": "Suite 104",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "40202",
            "country_code": "US",
            "telephone_number": "502-585-2924 x116",
            "fax_number": "502-585-2931",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "305 W Broadway",
            "address_2": "Suite 104",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "40202",
            "country_code": "US",
            "telephone_number": "502-585-2924 x116",
            "fax_number": "502-585-2931",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ENRIQUEZ",
        "first_name": "MARIETTA",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-27",
        "last_updated": "2019-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "22441",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "K215580",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64224413",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Louisville, KY
• Providers in Louisville, KY by specialty
• Pediatrics Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.