Provider Demographics
NPI:1548620586
Name:QUIROGA, JESSIKA
Entity type:Individual
Prefix:
First Name:JESSIKA
Middle Name:
Last Name:QUIROGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11144 EXCELSIOR DR
Mailing Address - Street 2:APT.6
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-5680
Mailing Address - Country:US
Mailing Address - Phone:562-278-4394
Mailing Address - Fax:
Practice Address - Street 1:11144 EXCELSIOR DR
Practice Address - Street 2:APT.6
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-5680
Practice Address - Country:US
Practice Address - Phone:562-278-4394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist