MEDICARE: MR. ALFRED MICHEAL QUINTANA CPO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1744P3200X	Prosthetics Case Management

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255420774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALFRED MICHEAL QUINTANA CPO

Provider Business Mailing Address
First Line	:	2365 HARRISON AVE
Second Line	:
City	:	EUREKA
State	:	CA
Zip	:	95501-3216
Country	:	US
Telephone Number	:	707-445-3111
Fax Number	:	707-442-8792

Provider Business Practice Location Address
First Line	:	2365 HARRISON AVE
Second Line	:
City	:	EUREKA
State	:	CA
Zip	:	95501-3216
Country	:	US
Telephone Number	:	707-445-3111
Fax Number	:	707-442-8792

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/09/2007

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