MEDICARE: MS. OLIVE M. CHUQUIMBALQUI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1952701781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. OLIVE M. CHUQUIMBALQUI

Provider Business Mailing Address
First Line	:	9974 N KENDALL DR
Second Line	:	APT.1002
City	:	MIAMI
State	:	FL
Zip	:	33176-1779
Country	:	US
Telephone Number	:	786-218-5147
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 NE 44TH ST
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33334-1423
Country	:	US
Telephone Number	:	954-462-4599
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2014
Last Update Date	:	10/11/2016

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