Provider Demographics
NPI:1598110025
Name:HOUSE OF Q RIGGS LLC
Entity Type:Organization
Organization Name:HOUSE OF Q RIGGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NON-SURGICAL HAIR REPLACEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARQUITA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-575-7032
Mailing Address - Street 1:2917 NE 16TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-3234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 NE 1ST ST
Practice Address - Street 2:SUITE 117
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-5311
Practice Address - Country:US
Practice Address - Phone:352-575-7032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCL12203681744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty