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General NPI Number Information
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NPI Number | 1063359024
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Entity Type | Individual
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Provider Name | CRYSTAL QUINTERO-AHUMADA
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Gender | Female
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Dates
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Enumeration Date | 04/29/2026
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Last Update Date | 04/29/2026
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Provider Practice Location Address
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Address Line | 9500 GILMAN DRIVE MAIL CODE 0602
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City | LA JOLLA
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State | CA
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Zip | 92093-0001
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Country | US
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Telephone | 858-534-2230
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Fax |
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Provider Business Mailing Address
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Address Line | 3739 MIRAMAR ST BOX 4029
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City | LA JOLLA
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State | CA
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Zip | 92037-1345
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Country | US
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Telephone | 831-710-0814
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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