Provider Demographics
NPI:1548917743
Name:MAYORQUIN, ROSALILY
Entity type:Individual
Prefix:
First Name:ROSALILY
Middle Name:
Last Name:MAYORQUIN
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 1:990 HIGHLAND DR STE 310
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2438
Mailing Address - Country:US
Mailing Address - Phone:619-961-2015
Mailing Address - Fax:
Practice Address - Street 1:990 HIGHLAND DR STE 310
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2438
Practice Address - Country:US
Practice Address - Phone:619-961-2015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician