Provider Demographics
NPI:1508381435
Name:TAQUIQUI, LOUIE
Entity Type:Individual
Prefix:MR
First Name:LOUIE
Middle Name:
Last Name:TAQUIQUI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3566 TUNDRA SWAN ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-3501
Mailing Address - Country:US
Mailing Address - Phone:702-806-5198
Mailing Address - Fax:
Practice Address - Street 1:3566 TUNDRA SWAN ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NE
Practice Address - Zip Code:89122
Practice Address - Country:US
Practice Address - Phone:702-806-5198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV2017143936251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health