Healthcare Provider Details

I. General information

NPI: 1336377662
Provider Name (Legal Business Name): JOHN PAULO QUITORIANO IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

III MARINE EXPEDITIONARY FORCE UNIT 35601
FPO AP
96605-5601
US

IV. Provider business mailing address

COMMANDING GENERAL III MARINE EXPEDITIONARY FORCE UNIT 35601, OKINAWA JAPAN
FPO AP
96605-5601
US

V. Phone/Fax

Practice location:
  • Phone: 310-817-4736
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: