Provider Demographics
NPI:1639056302
Name:BUQUE, JIANNA RAVEN QUILATON
Entity type:Individual
Prefix:MISS
First Name:JIANNA RAVEN
Middle Name:QUILATON
Last Name:BUQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-3211
Mailing Address - Country:US
Mailing Address - Phone:847-275-3726
Mailing Address - Fax:
Practice Address - Street 1:1203 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-3211
Practice Address - Country:US
Practice Address - Phone:847-275-3726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-16
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician