Provider Demographics
NPI:1437359270
Name:QUIROGA, CHARMA RODRIGUEZ (PT)
Entity Type:Individual
Prefix:MISS
First Name:CHARMA
Middle Name:RODRIGUEZ
Last Name:QUIROGA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHARMA
Other - Middle Name:RODRIGUEZ
Other - Last Name:QUIROGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12350 DEL AMO BLVD APT 1821
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715-1721
Mailing Address - Country:US
Mailing Address - Phone:562-916-4416
Mailing Address - Fax:
Practice Address - Street 1:12350 DEL AMO BLVD APT 1821
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90715-1721
Practice Address - Country:US
Practice Address - Phone:562-916-4416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPT40QA0119200225100000X
CAPT33703225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist