Provider Demographics
NPI:1811716913
Name:QUINONES VERDUGO, MILAGROS KIMBERLY
Entity type:Individual
Prefix:
First Name:MILAGROS
Middle Name:KIMBERLY
Last Name:QUINONES VERDUGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MILAGROS
Other - Middle Name:KIMBERLY
Other - Last Name:QUINONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:420 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-4918
Mailing Address - Country:US
Mailing Address - Phone:323-603-7183
Mailing Address - Fax:
Practice Address - Street 1:420 17TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4918
Practice Address - Country:US
Practice Address - Phone:323-603-7183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY3212162106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician