Healthcare Provider Details

I. General information

NPI: 1881490225
Provider Name (Legal Business Name): TERENCE QUILATAN FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17780 BOXWOOD DR
RIVERSIDE CA
92503-7034
US

IV. Provider business mailing address

17780 BOXWOOD DR
RIVERSIDE CA
92503-7034
US

V. Phone/Fax

Practice location:
  • Phone: 951-525-3427
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95033903
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: