Healthcare Provider Details

I. General information

NPI: 1417991373
Provider Name (Legal Business Name): JOSE LUIS QUIROGA PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 EMELINE AVE
SANTA CRUZ CA
95060-1976
US

IV. Provider business mailing address

1400 EMELINE AVE
SANTA CRUZ CA
95060-1976
US

V. Phone/Fax

Practice location:
  • Phone: 831-454-4170
  • Fax: 831-454-4971
Mailing address:
  • Phone: 831-454-4170
  • Fax: 831-454-4971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY17172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: