Healthcare Provider Details

I. General information

NPI: 1518159698
Provider Name (Legal Business Name): JONATHAN QUILLAO DYREYES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11311 GARVEY AVE
EL MONTE CA
91732-3301
US

IV. Provider business mailing address

11311 GARVEY AVE
EL MONTE CA
91732-3301
US

V. Phone/Fax

Practice location:
  • Phone: 909-729-5079
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA93977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: