MEDICARE: MICHAEL QUINES 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	2084P0800X	Psychiatry Physician	A104818	CA

General Provider Information

NPI Number	:	1689870420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL QUINES M.D.

Provider Business Mailing Address
First Line	:	325 W HOSPITALITY LN
Second Line	:	SUITE #312
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3243
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 W HOSPITALITY LN
Second Line	:	SUITE #312
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3243
Country	:	US
Telephone Number	:	909-427-5521
Fax Number	:

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

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	12/06/2021

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