Provider Demographics
NPI:1952701781
Name:CHUQUIMBALQUI, OLIVE M
Entity Type:Individual
Prefix:MS
First Name:OLIVE
Middle Name:M
Last Name:CHUQUIMBALQUI
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 1:9974 N KENDALL DR
Mailing Address - Street 2:APT.1002
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1779
Mailing Address - Country:US
Mailing Address - Phone:786-218-5147
Mailing Address - Fax:
Practice Address - Street 1:450 NE 44TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-1423
Practice Address - Country:US
Practice Address - Phone:954-462-4599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health