Provider Demographics
NPI:1083846158
Name:QUIJANO, ISABEL A (LD)
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:A
Last Name:QUIJANO
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12219 DEERTRACK LOOP
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34610-3384
Mailing Address - Country:US
Mailing Address - Phone:727-265-0665
Mailing Address - Fax:
Practice Address - Street 1:12219 DEERTRACK LOOP
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34610-3384
Practice Address - Country:US
Practice Address - Phone:727-265-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5580133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist