Healthcare Provider Details

I. General information

NPI: 1740427012
Provider Name (Legal Business Name): AL JOSE QUINTANA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E WASHINGTON ST SUITE 200
COLTON CA
92324-7111
US

IV. Provider business mailing address

399 E 21ST ST
SAN BERNARDINO CA
92404-4815
US

V. Phone/Fax

Practice location:
  • Phone: 909-882-5867
  • Fax: 909-503-1913
Mailing address:
  • Phone: 909-882-2266
  • Fax: 909-881-7593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20123
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: