Healthcare Provider Details

I. General information

NPI: 1104073782
Provider Name (Legal Business Name): KENNETH QUINTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GILMAN DRIVE
LA JOLLA CA
92093-0635
US

IV. Provider business mailing address

9500 GILMAN DRIVE
LA JOLLA CA
92093-0635
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-6248
  • Fax: 858-552-7425
Mailing address:
  • Phone: 619-543-6248
  • Fax: 858-552-7425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberA99090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: