Healthcare Provider Details

I. General information

NPI: 1194613729
Provider Name (Legal Business Name): EDGAR DAMIAN QUINTANA HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1467 N WANDA RD STE 135
ORANGE CA
92867-5344
US

IV. Provider business mailing address

1467 N WANDA RD STE 135
ORANGE CA
92867-5344
US

V. Phone/Fax

Practice location:
  • Phone: 657-272-0426
  • Fax:
Mailing address:
  • Phone: 714-766-9934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA8724
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: