Provider Demographics
NPI:1124560636
Name:QUIROGA, ROGGERD RICARDO
Entity Type:Individual
Prefix:
First Name:ROGGERD
Middle Name:RICARDO
Last Name:QUIROGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 RAINBOW RD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-2806
Mailing Address - Country:US
Mailing Address - Phone:203-952-3448
Mailing Address - Fax:
Practice Address - Street 1:9 RAINBOW RD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-2806
Practice Address - Country:US
Practice Address - Phone:203-952-3448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer