Provider Demographics
NPI:1982211645
Name:QUIROZ GUERRERO, JENNIT JACQUELINE
Entity Type:Individual
Prefix:
First Name:JENNIT
Middle Name:JACQUELINE
Last Name:QUIROZ GUERRERO
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 1:1355 W 53RD ST APT 323
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3075
Mailing Address - Country:US
Mailing Address - Phone:786-609-6971
Mailing Address - Fax:
Practice Address - Street 1:1355 W 53RD ST APT 323
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3075
Practice Address - Country:US
Practice Address - Phone:786-609-6971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician