Physician Compare National (NPI:1730390691)

HEALTHCARE PROVIDER:

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1730390691
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3678662632
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20071129000166
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	VALEROS
	Individual professional last name
Provider First Name	QUIRINO
	Individual professional first name
Provider Middle Name	B
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OAKLAND COLLEGE OF MEDICINE AND SURGERY
	Individual professional's medical school
Graduation Year	1966
	Individual professional's medical school graduation year
Primary Specialty	GENERAL PRACTICE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	FAMILY MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	FAMILY MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	CEB CAPITAL LLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	0244537561
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	3
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	9150 W INDIAN SCHOOL RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 111B
	Group Practice or individual's line 2 address
City	PHOENIX
	Group Practice or individual's city
State	AZ
	Group Practice or individual's state
Zip Code	850372354
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6232472300
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y