Healthcare Provider Details

I. General information

NPI: 1851817019
Provider Name (Legal Business Name): CHIQUILA NERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2017
Last Update Date: 08/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 LAKE FOREST BLVD STE 607
NEW ORLEANS LA
70127-6201
US

IV. Provider business mailing address

218 W GATEHOUSE DR APT C
METAIRIE LA
70001-2073
US

V. Phone/Fax

Practice location:
  • Phone: 504-265-1230
  • Fax:
Mailing address:
  • Phone: 504-913-5107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: