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General NPI Number Information
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NPI Number | 1124214838
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Entity Type | Organization
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Legal Business Name | WALTER Y. QUIJANO, PH.D., P.C.
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 09/18/2007
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Provider Practice Location Address
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Address Line | 901 N THOMPSON ST
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City | CONROE
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State | TX
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Zip | 77301-2554
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Country | US
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Telephone | 936-539-2226
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Fax | 936-788-5897
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Provider Business Mailing Address
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Address Line | 901 N THOMPSON ST
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City | CONROE
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State | TX
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Zip | 77301-2554
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Country | US
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Telephone | 936-539-2226
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Fax | 936-788-5897
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Authorized Official
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Title or Position | PRESIDENT
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Name | WALTER Y. QUIJANO
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Credential | PH.D.
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Telephone | 936-539-2226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 21679
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License Number State | TX
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