Healthcare Provider Details

I. General information

NPI: 1184773046
Provider Name (Legal Business Name): ABRAHAM QUINTEROS LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 RALSTON ST STE 312
VENTURA CA
93003-6050
US

IV. Provider business mailing address

515 E DE LA GUERRA ST
SANTA BARBARA CA
93103-3009
US

V. Phone/Fax

Practice location:
  • Phone: 805-642-7033
  • Fax: 805-642-7732
Mailing address:
  • Phone: 805-965-7387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN216090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: