Provider Demographics
NPI:1043946411
Name:RIQUELME, KYARA ISIS
Entity Type:Individual
Prefix:
First Name:KYARA
Middle Name:ISIS
Last Name:RIQUELME
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 1:8345 116TH ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-3454
Mailing Address - Country:US
Mailing Address - Phone:646-620-5203
Mailing Address - Fax:
Practice Address - Street 1:8345 116TH ST APT 2F
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-3454
Practice Address - Country:US
Practice Address - Phone:646-620-5203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator