Healthcare Provider Details

I. General information

NPI: 1093373342
Provider Name (Legal Business Name): VANESSA ANTONIA QUINTANA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2019
Last Update Date: 06/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4164 BROCKTON AVE STE A
RIVERSIDE CA
92501-3400
US

IV. Provider business mailing address

93 KANSAS ST APT 204
REDLANDS CA
92373-1469
US

V. Phone/Fax

Practice location:
  • Phone: 951-888-1346
  • Fax:
Mailing address:
  • Phone: 909-963-6503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: