1619485844 NPI number — SOFIA ANDREA QUIJANO KRALJEVIC MS, LAT, ATC

Table of content: SOFIA ANDREA QUIJANO KRALJEVIC MS, LAT, ATC (NPI 1619485844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619485844 NPI number — SOFIA ANDREA QUIJANO KRALJEVIC MS, LAT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUIJANO KRALJEVIC
Provider First Name:
SOFIA
Provider Middle Name:
ANDREA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LAT, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619485844
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22260 VALLEY RANCH PKWY APT 8312
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77365-7448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21580 LOOP 494
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CANEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77357-8239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-449-4433
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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