Healthcare Provider Details

I. General information

NPI: 1255648705
Provider Name (Legal Business Name): EDWARD APOLINARIO QUINTOS PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2010
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 W 8TH ST SUITE 100
LOS ANGELES CA
90017-4420
US

IV. Provider business mailing address

4406 EARLE AVE
ROSEMEAD CA
91770-1154
US

V. Phone/Fax

Practice location:
  • Phone: 213-401-1985
  • Fax: 213-401-1987
Mailing address:
  • Phone: 626-487-7062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8653
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: