Healthcare Provider Details

I. General information

NPI: 1467576421
Provider Name (Legal Business Name): JAMES WILLIAM QUINONES PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 01/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14514 RAMONA BLVD SUITE 3
BALDWIN PARK CA
91706-3305
US

IV. Provider business mailing address

14514 RAMONA BOULVEVARD SUITE 3
BALDWINPARK CA
91706
US

V. Phone/Fax

Practice location:
  • Phone: 626-337-0424
  • Fax: 626-813-9095
Mailing address:
  • Phone: 626-337-0424
  • Fax: 626-813-9095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberPA12379
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 12379
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: