Healthcare Provider Details

I. General information

NPI: 1861582314
Provider Name (Legal Business Name): CECILIA TALPA QUINONES P.A.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 N. MOUNT VERNON AVE.
SAN BERNARDINO CA
92411
US

IV. Provider business mailing address

685 CARNEGIE DR. SUITE 230
SAN BERNARDINO CA
92408-3583
US

V. Phone/Fax

Practice location:
  • Phone: 909-884-9091
  • Fax: 909-383-7013
Mailing address:
  • Phone: 909-890-0407
  • Fax: 909-890-0575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13303
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: