Healthcare Provider Details

I. General information

NPI: 1598968638
Provider Name (Legal Business Name): MRS. ANNELLY QUIROZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 SUMAC DR
AURORA IL
60506-8874
US

IV. Provider business mailing address

650 SUMAC DR
AURORA IL
60506-8874
US

V. Phone/Fax

Practice location:
  • Phone: 630-209-0390
  • Fax: 630-801-5144
Mailing address:
  • Phone: 630-209-0390
  • Fax: 630-801-5144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: