Individual
DR. KIMBERLY C. RIQUELME
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1353 GOLD STAR HWY, GROTON, CT 06340
(860) 449-9947
Mailing address
1353 GOLD STAR HWY, GROTON, CT 06340-2739
(860) 449-9947
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
54151
CT
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
54151
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54151
LICENSE
CT
Enumeration date
08/09/2010
Last updated
07/03/2018
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