Provider Demographics
NPI:1376239244
Name:QUIWA, ALEJANDRA DIZON
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:DIZON
Last Name:QUIWA
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 1:662 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-5539
Mailing Address - Country:US
Mailing Address - Phone:862-295-8598
Mailing Address - Fax:
Practice Address - Street 1:198 OLD CASTLE POINT RD
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-7069
Practice Address - Country:US
Practice Address - Phone:862-295-8598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care