Healthcare Provider Details

I. General information

NPI: 1063359024
Provider Name (Legal Business Name): CRYSTAL QUINTERO-AHUMADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GILMAN DRIVE MAIL CODE 0602
LA JOLLA CA
92093-0001
US

IV. Provider business mailing address

3739 MIRAMAR ST BOX 4029
LA JOLLA CA
92037-1345
US

V. Phone/Fax

Practice location:
  • Phone: 858-534-2230
  • Fax:
Mailing address:
  • Phone: 831-710-0814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: