Provider Demographics
NPI:1356626147
Name:JOSSIE QUIROGA
Entity Type:Organization
Organization Name:JOSSIE QUIROGA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSSIE
Authorized Official - Middle Name:TERESITA
Authorized Official - Last Name:QUIROGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-223-4332
Mailing Address - Street 1:PO BOX 1305
Mailing Address - Street 2:
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85628-1305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:SAN PEDRO 287
Practice Address - Street 2:
Practice Address - City:HERMOSILLO
Practice Address - State:SONORA
Practice Address - Zip Code:83287
Practice Address - Country:MX
Practice Address - Phone:644-174-0111
Practice Address - Fax:644-118-9566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage