Healthcare Provider Details

I. General information

NPI: 1154180982
Provider Name (Legal Business Name): QUIANA DESILVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 MERIDIAN AVE
SAN JOSE CA
95125-5350
US

IV. Provider business mailing address

PO BOX 10037
SAN JOSE CA
95157-1037
US

V. Phone/Fax

Practice location:
  • Phone: 408-775-1789
  • Fax:
Mailing address:
  • Phone: 408-775-1789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: