Healthcare Provider Details

I. General information

NPI: 1598276834
Provider Name (Legal Business Name): NINIVE ALEJANDRA QUIJADA DENTAL HYGIENIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 F AVE
DOUGLAS AZ
85607-1919
US

IV. Provider business mailing address

155 CALLE PORTAL STE 100
SIERRA VISTA AZ
85635-2900
US

V. Phone/Fax

Practice location:
  • Phone: 520-364-3285
  • Fax: 520-515-8663
Mailing address:
  • Phone: 520-515-8673
  • Fax: 520-515-8663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: