Healthcare Provider Details

I. General information

NPI: 1942810635
Provider Name (Legal Business Name): MOISES QUINTERO TOVAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 S SAN ANTONIO RD
GOLETA CA
93110-1720
US

IV. Provider business mailing address

66 S SAN ANTONIO RD
GOLETA CA
93110-1720
US

V. Phone/Fax

Practice location:
  • Phone: 424-227-0002
  • Fax:
Mailing address:
  • Phone: 424-227-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: