Provider Demographics
NPI:1396807053
Name:QUIROGA, ISIDRO RAMON (PHD)
Entity type:Individual
Prefix:DR
First Name:ISIDRO
Middle Name:RAMON
Last Name:QUIROGA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 MAIN ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-4614
Mailing Address - Country:US
Mailing Address - Phone:831-728-2028
Mailing Address - Fax:831-479-8920
Practice Address - Street 1:420 MAIN ST
Practice Address - Street 2:SUITE 307
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4614
Practice Address - Country:US
Practice Address - Phone:831-728-2028
Practice Address - Fax:831-479-8920
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4256103TC0700X
CAPSY 4256103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL42560Medicare ID - Type Unspecified