Healthcare Provider Details

I. General information

NPI: 1417485848
Provider Name (Legal Business Name): JOHNIECE R QUINTANA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 DOWNEY AVE
MODESTO CA
95354-1208
US

IV. Provider business mailing address

4132 E ORANGEBURG AVE
MODESTO CA
95355-9521
US

V. Phone/Fax

Practice location:
  • Phone: 209-289-7958
  • Fax:
Mailing address:
  • Phone: 209-289-7958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: