Healthcare Provider Details

I. General information

NPI: 1124108972
Provider Name (Legal Business Name): MARIA LOURDES QUINONEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 THIRD STREET SUITE E
SAN RAFAEL CA
94901
US

IV. Provider business mailing address

361 THIRD STREET SUITE E
SAN RAFAEL CA
94901
US

V. Phone/Fax

Practice location:
  • Phone: 415-499-4030
  • Fax: 415-507-2634
Mailing address:
  • Phone: 415-499-4030
  • Fax: 415-507-2634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number532613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: