Provider Demographics
NPI:1063291573
Name:SOLER QUEVEDO, NOEL D
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:D
Last Name:SOLER QUEVEDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 FAIRLANE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-5089
Mailing Address - Country:US
Mailing Address - Phone:321-287-8307
Mailing Address - Fax:
Practice Address - Street 1:203 FAIRLANE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5089
Practice Address - Country:US
Practice Address - Phone:321-287-8307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician