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General NPI Number Information
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NPI Number | 1669629655
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Entity Type | Individual
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Provider Name | TERESA QUIROGA
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Gender | Female
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Dates
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Enumeration Date | 08/21/2008
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Last Update Date | 08/21/2008
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Provider Practice Location Address
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Address Line | 101 N 2ND ST
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City | RATON
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State | NM
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Zip | 87740-3803
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Country | US
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Telephone | 505-445-7090
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 982
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City | LA VETA
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State | CO
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Zip | 81055-0982
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Country | US
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Telephone | 719-742-0219
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 329265
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License Number State | NM
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