Healthcare Provider Details

I. General information

NPI: 1841258084
Provider Name (Legal Business Name): VICTOR JOSEPH QUIJANO JR. DPM, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 TSIENNETO RD SUITE 303
DERRY NH
03038-1584
US

IV. Provider business mailing address

6 TSIENNETO RD SUITE 303
DERRY NH
03038-1584
US

V. Phone/Fax

Practice location:
  • Phone: 603-432-2508
  • Fax: 603-432-2008
Mailing address:
  • Phone: 603-432-2508
  • Fax: 603-432-2008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2304
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: