Provider Demographics
NPI:1003197260
Name:QUENTELA, KARINA MACTAL (RPH)
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:MACTAL
Last Name:QUENTELA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15650 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-1240
Mailing Address - Country:US
Mailing Address - Phone:510-243-1100
Mailing Address - Fax:510-243-0527
Practice Address - Street 1:15650 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-1240
Practice Address - Country:US
Practice Address - Phone:510-243-1100
Practice Address - Fax:510-243-0527
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65645183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist