Healthcare Provider Details

I. General information

NPI: 1104208966
Provider Name (Legal Business Name): LIZBETH QUINTERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9916 CENTRAL AVE
MONTCLAIR CA
91763-3201
US

IV. Provider business mailing address

26260 PARTON CT
MORENO VALLEY CA
92555-1859
US

V. Phone/Fax

Practice location:
  • Phone: 909-621-7068
  • Fax: 909-418-6937
Mailing address:
  • Phone: 951-442-7765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
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: