Provider Demographics
NPI:1407336555
Name:QUICHO, MARIA LOUISA BANAAG
Entity Type:Individual
Prefix:
First Name:MARIA LOUISA
Middle Name:BANAAG
Last Name:QUICHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LOUISA
Other - Middle Name:BANAAG
Other - Last Name:QUICHO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18600 S FIGUEROA ST STE 119
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-4505
Mailing Address - Country:US
Mailing Address - Phone:310-850-9253
Mailing Address - Fax:
Practice Address - Street 1:25821 VERMONT AVE
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-3518
Practice Address - Country:US
Practice Address - Phone:424-251-7133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17916227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered