Healthcare Provider Details

I. General information

NPI: 1700665171
Provider Name (Legal Business Name): CELINA TIFANNY VALDIVIEZO QUINONEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 09/26/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 LAKE ST APT 5F
WHITE PLAINS NY
10603-4012
US

IV. Provider business mailing address

30 LAKE ST APT 5F
WHITE PLAINS NY
10603-4012
US

V. Phone/Fax

Practice location:
  • Phone: 914-623-3544
  • Fax:
Mailing address:
  • Phone: 914-623-3544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number847623
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: