Healthcare Provider Details

I. General information

NPI: 1518405893
Provider Name (Legal Business Name): AUDREY RONQUILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2017
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7811 SANTA FE ST
FONTANA CA
92336-3324
US

IV. Provider business mailing address

277 E AMADOR AVE STE 101
LAS CRUCES NM
88001-3675
US

V. Phone/Fax

Practice location:
  • Phone: 310-853-1170
  • Fax:
Mailing address:
  • Phone: 575-520-6074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: