Healthcare Provider Details

I. General information

NPI: 1528067089
Provider Name (Legal Business Name): EDWARD ENRIQUE QUIROZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 E WASHINGTON ST SUITE 106
PHOENIX AZ
85034-1052
US

IV. Provider business mailing address

809 E WASHINGTON ST SUITE 106
PHOENIX AZ
85034-1052
US

V. Phone/Fax

Practice location:
  • Phone: 602-340-9455
  • Fax: 602-253-5359
Mailing address:
  • Phone: 602-340-1429
  • Fax: 602-340-1327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number16323
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: