Individual
MR. SIYANDA OBED MQUQWANA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
1453 N MAIN STREET, SUITE F, SAN LUIS, AZ 85349
(928) 627-6567
Mailing address
1215 W 13TH PL, YUMA, AZ 85364-4480
(928) 317-0128
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2855
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
719643
AHCCCS PROVIDER ID
AZ
Enumeration date
02/23/2007
Last updated
07/08/2007
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