Healthcare Provider Details

I. General information

NPI: 1275963100
Provider Name (Legal Business Name): ANDREA QUINONES-RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2013
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE BLDG 25
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

1200 N STATE ST GNH 1060K
LOS ANGELES CA
90089-1001
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-5753
  • Fax: 415-206-5818
Mailing address:
  • Phone: 323-409-7053
  • Fax: 323-226-7927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA179223
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: