Provider Demographics
NPI:1588205876
Name:QUIROGA, MIRIAM AIDEE
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:AIDEE
Last Name:QUIROGA
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 1:3898 JUDY MARIE LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-9029
Mailing Address - Country:US
Mailing Address - Phone:915-471-8639
Mailing Address - Fax:
Practice Address - Street 1:3898 JUDY MARIE LN
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-9029
Practice Address - Country:US
Practice Address - Phone:915-471-8639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143024363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner