Healthcare Provider Details

I. General information

NPI: 1871864405
Provider Name (Legal Business Name): MILAGROS OQUENDO MSW/LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5229 OLD STRASBURG RD
KINZERS PA
17535-9750
US

IV. Provider business mailing address

5229 OLD STRASBURG RD
KINZERS PA
17535-9750
US

V. Phone/Fax

Practice location:
  • Phone: 717-442-7931
  • Fax:
Mailing address:
  • Phone: 717-442-7931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW011940L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: