MEDICARE: JUAN CARLOS QUIROS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	A45774	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HK459Z	OTHER	CA	MEDICARE

General Provider Information

NPI Number	:	1689679607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN CARLOS QUIROS M.D.

Provider Business Mailing Address
First Line	:	675 N. EUCLID STREET
Second Line	:	#628
City	:	ANAHEIM
State	:	CA
Zip	:	92801
Country	:	US
Telephone Number	:	714-808-9797
Fax Number	:	714-808-9393

Provider Business Practice Location Address
First Line	:	1735 W ROMNEYA DR
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92801-1804
Country	:	US
Telephone Number	:	714-591-0456
Fax Number	:	888-508-0709

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	03/17/2018

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