Provider Demographics
NPI:1164830246
Name:QUIROS, JORGE
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:QUIROS
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 1:8175 NW 12TH ST STE 306
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1828
Mailing Address - Country:US
Mailing Address - Phone:786-845-0173
Mailing Address - Fax:305-470-5846
Practice Address - Street 1:8175 NW 12TH ST STE 306
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1828
Practice Address - Country:US
Practice Address - Phone:786-845-0173
Practice Address - Fax:305-470-5846
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9332245163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse