Healthcare Provider Details

I. General information

NPI: 1962186783
Provider Name (Legal Business Name): STEPHANIE MONIQUE QUINTANILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 S CENTRAL ST
VISALIA CA
93277-4418
US

IV. Provider business mailing address

1840 S CENTRAL ST
VISALIA CA
93277-4418
US

V. Phone/Fax

Practice location:
  • Phone: 559-471-4050
  • Fax:
Mailing address:
  • Phone: 559-471-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: