Provider Demographics
NPI:1598276834
Name:QUIJADA, NINIVE ALEJANDRA (DENTAL HYGIENIST)
Entity Type:Individual
Prefix:
First Name:NINIVE
Middle Name:ALEJANDRA
Last Name:QUIJADA
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 CALLE PORTAL STE 100
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2900
Mailing Address - Country:US
Mailing Address - Phone:520-515-8673
Mailing Address - Fax:520-515-8663
Practice Address - Street 1:1100 F AVE
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607-1919
Practice Address - Country:US
Practice Address - Phone:520-364-3285
Practice Address - Fax:520-515-8663
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPENDINGMedicaid