Healthcare Provider Details

I. General information

NPI: 1902091309
Provider Name (Legal Business Name): RAFAEL EDUARDO QUINONEZ M.D., PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2007
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11550 INDIAN HILLS RD STE 280
MISSION HILLS CA
91345-1244
US

IV. Provider business mailing address

11550 INDIAN HILLS RD STE 280
MISSION HILLS CA
91345-1244
US

V. Phone/Fax

Practice location:
  • Phone: 818-361-5069
  • Fax: 818-837-3411
Mailing address:
  • Phone: 818-361-5069
  • Fax: 818-837-3411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA101502
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: