Healthcare Provider Details

I. General information

NPI: 1326391251
Provider Name (Legal Business Name): MAGDALENA ISABEL QUINTANILLA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11704 WILSHIRE BLVD
LOS ANGELES CA
90025-1507
US

IV. Provider business mailing address

1235 W HACKBERRY AVE
ALAMO TX
78516-3732
US

V. Phone/Fax

Practice location:
  • Phone: 310-494-1422
  • Fax: 310-496-0868
Mailing address:
  • Phone: 956-787-8615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number39334
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: