MEDICARE: DR. FABIOLA QUINTERO-RIVERA MD

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	207SC0300X	Clinical Cytogenetics Physician	MTO00000497	CA

General Provider Information

NPI Number	:	1891344578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FABIOLA QUINTERO-RIVERA MD

Provider Business Mailing Address
First Line	:	1305 PALISADES DR
Second Line	:
City	:	PACIFIC PALISADES
State	:	CA
Zip	:	90272-2153
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 VETERAN AVE # 22-12H
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-2704
Country	:	US
Telephone Number	:	617-791-2743
Fax Number	:

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

Provider Enumeration Date	:	09/05/2019
Last Update Date	:	09/05/2019

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