Provider Demographics
NPI:1689206153
Name:QUILES, MIRCA
Entity Type:Individual
Prefix:
First Name:MIRCA
Middle Name:
Last Name:QUILES
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 1:13729 ROYSTON BND
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34669-5007
Mailing Address - Country:US
Mailing Address - Phone:973-519-3577
Mailing Address - Fax:
Practice Address - Street 1:13729 ROYSTON BND
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34669-5007
Practice Address - Country:US
Practice Address - Phone:973-519-3577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist