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1740427012 NPI number — AL JOSE QUINTANA PA-C

NPI Number: 1740427012
Health Care Provider/Practitioner: AL JOSE QUINTANA PA-C

Information about “1740427012” NPI (AL JOSE QUINTANA PA-C) exists in 1740427012 in HTML format HTML  |  1740427012 in plain Text format TXT  |  1740427012 in PDF (Portable Document Format) PDF  |  1740427012 in an XML format XML  formats.

NPI Number : 1740427012 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1740427012",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "QUINTANA",
    "FirstName": "AL",
    "MiddleName": "JOSE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "399 E 21ST ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAN BERNARDINO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92404-4815",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "909-882-2266",
    "MailingAddressFaxNumber": "909-881-7593",
    "FirstLinePracticeLocationAddress": "900 E WASHINGTON ST",
    "SecondLinePracticeLocationAddress": "SUITE 200",
    "PracticeLocationAddressCityName": "COLTON",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92324-7111",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "909-882-5867",
    "PracticeLocationAddressFaxNumber": "909-503-1913",
    "EnumerationDate": "01/08/2009",
    "LastUpdateDate": "10/27/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "PA20123",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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