Individual
MARIE LORRAINE ALQUISALAS CESA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
124 BETTIS ACADEMY RD, GRANITEVILLE, SC 29829-3107
(803) 392-3724
(803) 234-5593
Mailing address
367 S GULPH RD, ATTN IPM CREDENTIALING, KING OF PRUSSIA, PA 19406-3121
(803) 392-3724
(803) 234-5593
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
86692
SC
Other
Enumeration date
08/04/2018
Last updated
10/26/2021
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