Provider Demographics
NPI:1063946887
Name:QUIROZ MEJIA, INGRID VICTORIA (SA-C)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:VICTORIA
Last Name:QUIROZ MEJIA
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10155 NW 9TH STREET CIR
Mailing Address - Street 2:APT 405
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-6620
Mailing Address - Country:US
Mailing Address - Phone:786-818-2380
Mailing Address - Fax:
Practice Address - Street 1:10155 NW 9TH STREET CIR
Practice Address - Street 2:APT 405
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-6620
Practice Address - Country:US
Practice Address - Phone:786-818-2380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17-218246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant