Individual
TAQUILLA MIMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
29701 6 MILE RD STE 150A, LIVONIA, MI 48152-8604
(313) 802-1787
Mailing address
17625 W 7 MILE RD UNIT 351271, DETROIT, MI 48235-7747
(313) 802-1787
(313) 668-6127
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
01/27/2020
Last updated
01/27/2020
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