Healthcare Provider Details

I. General information

NPI: 1417836123
Provider Name (Legal Business Name): LARRY LOUIE QUINTANAR JR. LPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 FAIR OAKS AVE STE 125 & 300
SOUTH PASADENA CA
91030-2688
US

IV. Provider business mailing address

625 FAIR OAKS AVE STE 125 & 300
SOUTH PASADENA CA
91030-2688
US

V. Phone/Fax

Practice location:
  • Phone: 626-441-4221
  • Fax:
Mailing address:
  • Phone: 626-441-4221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberLPT43089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: