Provider Demographics
NPI:1003304783
Name:QUIJAS, JUAN FERNANDO (BS)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:FERNANDO
Last Name:QUIJAS
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 YORI AVE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-4325
Mailing Address - Country:US
Mailing Address - Phone:775-320-0312
Mailing Address - Fax:775-329-0946
Practice Address - Street 1:2725 YORI AVE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-4325
Practice Address - Country:US
Practice Address - Phone:775-320-0312
Practice Address - Fax:775-329-0946
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20051768948101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health