Provider Demographics
NPI:1942443007
Name:WESTERN QUALITY GROUP
Entity Type:Organization
Organization Name:WESTERN QUALITY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PREDIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDURADO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIRINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-300-8380
Mailing Address - Street 1:15476 NW 77TH CT
Mailing Address - Street 2:SUITE355
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5823
Mailing Address - Country:US
Mailing Address - Phone:305-300-8380
Mailing Address - Fax:305-675-0381
Practice Address - Street 1:15476 NW 77TH CT
Practice Address - Street 2:SUITE355
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5823
Practice Address - Country:US
Practice Address - Phone:305-300-8380
Practice Address - Fax:305-675-0381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-19
Last Update Date:2009-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72685305R00000X
FLPT7871305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization