Healthcare Provider Details

I. General information

NPI: 1154895506
Provider Name (Legal Business Name): CHRISTIAN QUIJANO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 CENTRAL AVE STE 105
LOS ALAMOS NM
87544-6217
US

IV. Provider business mailing address

1350 CENTRAL AVE STE 105
LOS ALAMOS NM
87544-6217
US

V. Phone/Fax

Practice location:
  • Phone: 505-662-3384
  • Fax:
Mailing address:
  • Phone: 505-662-3384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0015893
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5437
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: