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General NPI Number Information
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NPI Number | 1154895506
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Entity Type | Individual
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Provider Name | CHRISTIAN QUIJANO DPT
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Gender | Male
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Dates
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Enumeration Date | 01/18/2019
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 1350 CENTRAL AVE STE 105
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City | LOS ALAMOS
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State | NM
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Zip | 87544-6217
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Country | US
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Telephone | 505-662-3384
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Fax |
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Provider Business Mailing Address
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Address Line | 1350 CENTRAL AVE STE 105
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City | LOS ALAMOS
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State | NM
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Zip | 87544-6217
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Country | US
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Telephone | 505-662-3384
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTL.0015893
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5437
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License Number State | NM
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