Provider Demographics
NPI:1851817019
Name:NERO, CHIQUILA
Entity Type:Individual
Prefix:
First Name:CHIQUILA
Middle Name:
Last Name:NERO
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 1:218 W GATEHOUSE DR APT C
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-2073
Mailing Address - Country:US
Mailing Address - Phone:504-913-5107
Mailing Address - Fax:
Practice Address - Street 1:10001 LAKE FOREST BLVD STE 607
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-6201
Practice Address - Country:US
Practice Address - Phone:504-265-1230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-19
Last Update Date:2017-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251S00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health