MEDICARE: GABRIEL PAUL QUINTANILLA

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1447432729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL PAUL QUINTANILLA

Provider Business Mailing Address
First Line	:	27349 JEFFERSON AVE STE 100
Second Line	:
City	:	TEMECULA
State	:	CA
Zip	:	92590-5611
Country	:	US
Telephone Number	:	951-699-2451
Fax Number	:	951-699-2453

Provider Business Practice Location Address
First Line	:	27349 JEFFERSON AVE STE 100
Second Line	:
City	:	TEMECULA
State	:	CA
Zip	:	92590-5611
Country	:	US
Telephone Number	:	800-758-7571
Fax Number	:	888-223-1049

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

Provider Enumeration Date	:	11/29/2007
Last Update Date	:	01/13/2022

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