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General NPI Number Information
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NPI Number | 1093263550
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Entity Type | Individual
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Provider Name | KATHLEEN RONQUILLO
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Gender | Female
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Dates
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Enumeration Date | 09/13/2016
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Last Update Date | 09/13/2016
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Provider Practice Location Address
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Address Line | 3821 E SIERRA MADRE BLVD
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City | PASADENA
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State | CA
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Zip | 91107-1948
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Country | US
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Telephone | 626-351-1300
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Fax | 626-351-1328
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Provider Business Mailing Address
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Address Line | 535 N ORANGE AVE
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City | AZUSA
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State | CA
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Zip | 91702-2830
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Country | US
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Telephone | 626-513-3114
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Fax | 626-969-7280
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95004944
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License Number State | CA
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