Provider Demographics
NPI:1184457939
Name:QUEIROLO, KALINA ASHLEY
Entity type:Individual
Prefix:
First Name:KALINA
Middle Name:ASHLEY
Last Name:QUEIROLO
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 1:6422 SW 133RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5069
Mailing Address - Country:US
Mailing Address - Phone:786-479-3307
Mailing Address - Fax:
Practice Address - Street 1:6422 SW 133RD PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-5069
Practice Address - Country:US
Practice Address - Phone:786-479-3307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1164417106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician