Provider Demographics
NPI:1134619232
Name:QUEBRADA, KEYLA
Entity type:Individual
Prefix:
First Name:KEYLA
Middle Name:
Last Name:QUEBRADA
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 1:13121 131ST ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-3412
Mailing Address - Country:US
Mailing Address - Phone:347-971-7069
Mailing Address - Fax:
Practice Address - Street 1:13121 131ST ST
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-3412
Practice Address - Country:US
Practice Address - Phone:347-971-7069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst