Provider Demographics
NPI:1093076630
Name:RIQUELME, LUIS F (PHD,CCC-SLP,BRS-S)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:F
Last Name:RIQUELME
Suffix:
Gender:M
Credentials:PHD,CCC-SLP,BRS-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SAW MILL RIVER RAOD-2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-1533
Mailing Address - Country:US
Mailing Address - Phone:888-633-0033
Mailing Address - Fax:914-593-1802
Practice Address - Street 1:30 PLAZA W
Practice Address - Street 2:VOSBURGH PAVILION
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1572
Practice Address - Country:US
Practice Address - Phone:914-594-4912
Practice Address - Fax:914-594-4853
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5600-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist