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NPI Code Detail

MEDICARE: EDIELY QUIROS GAETAN

MEDICARE: EDIELY QUIROS GAETAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst8665FL

General Provider Information

NPI Number : 1831618107
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDIELY QUIROS GAETAN
Provider Business Mailing Address
First Line : 10175 FORTUNE PKWY UNIT 903
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-6755
Country : US
Telephone Number : 904-538-0713
Fax Number : 904-538-0714
Provider Business Practice Location Address
First Line : 782 FOXRIDGE CENTER DR
Second Line :
City : ORANGE PARK
State : FL
Zip : 32065-5776
Country : US
Telephone Number : 904-538-0713
Fax Number : 904-538-0714
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2017
Last Update Date : 03/17/2018

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Directions to “ EDIELY QUIROS GAETAN ” Practice Location

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