Provider Demographics
NPI:1760203400
Name:LIQUIDANO CHENAL, MIGUEL ANGEL (AUD)
Entity type:Individual
Prefix:DR
First Name:MIGUEL ANGEL
Middle Name:
Last Name:LIQUIDANO CHENAL
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21641 CANADA RD APT 19L
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2774
Mailing Address - Country:US
Mailing Address - Phone:334-559-2103
Mailing Address - Fax:
Practice Address - Street 1:24 S WEBER ST STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1928
Practice Address - Country:US
Practice Address - Phone:866-226-8576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU3786246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic