Provider Demographics
NPI:1770739039
Name:QUEVEDO, MARJORIE I (RDCS, RVT, RDMS)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:I
Last Name:QUEVEDO
Suffix:
Gender:F
Credentials:RDCS, RVT, RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 W GORE ST
Mailing Address - Street 2:STE 202
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1124
Mailing Address - Country:US
Mailing Address - Phone:407-788-0455
Mailing Address - Fax:407-389-0931
Practice Address - Street 1:70 W GORE ST
Practice Address - Street 2:STE 202
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1124
Practice Address - Country:US
Practice Address - Phone:407-788-0455
Practice Address - Fax:407-389-0931
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1187152471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography