Healthcare Provider Details

I. General information

NPI: 1356626147
Provider Name (Legal Business Name): JOSSIE QUIROGA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN PEDRO 287
HERMOSILLO SONORA
83287
MX

IV. Provider business mailing address

PO BOX 1305
NOGALES AZ
85628-1305
US

V. Phone/Fax

Practice location:
  • Phone: 644-174-0111
  • Fax: 644-118-9566
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. JOSSIE TERESITA QUIROGA
Title or Position: MANAGER
Credential:
Phone: 520-223-4332