Individual
MARCO ANTONIO RIQUELME
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 514-2500
Mailing address
777 N RAYMOND ST, BOISE, ID 83704-9251
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/17/2025
Last updated
07/17/2025
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