Healthcare Provider Details

I. General information

NPI: 1710421656
Provider Name (Legal Business Name): MRS. RONALEEN ALQUIZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS RONALEEN LORENZANA

II. Dates (important events)

Enumeration Date: 12/12/2016
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 GEORGIA AVE STE 411
SILVER SPRING MD
20910
US

IV. Provider business mailing address

8701 GEORGIA AVE STE 411
SILVER SPRING MD
20910-3713
US

V. Phone/Fax

Practice location:
  • Phone: 301-392-7075
  • Fax: 301-576-5487
Mailing address:
  • Phone: 301-392-7075
  • Fax: 301-576-5487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior 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: