Provider Demographics
NPI:1821217712
Name:QUIROGA, MICHELE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:QUIROGA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 LEJEUNE RD.
Mailing Address - Street 2:SUITE 530
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134
Mailing Address - Country:US
Mailing Address - Phone:305-215-5960
Mailing Address - Fax:305-675-2899
Practice Address - Street 1:2655 LEJEUNE RD.
Practice Address - Street 2:SUITE 530
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:305-215-5960
Practice Address - Fax:305-675-2899
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5776103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54783Medicare ID - Type Unspecified