Provider Demographics
NPI:1194383174
Name:BAQUERO, SANDRA ROCIO
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ROCIO
Last Name:BAQUERO
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 1:1300 NE 109TH ST APT 208
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-7321
Mailing Address - Country:US
Mailing Address - Phone:786-955-4807
Mailing Address - Fax:
Practice Address - Street 1:1300 NE 109TH ST APT 208
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-7321
Practice Address - Country:US
Practice Address - Phone:786-955-4807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst