Provider Demographics
NPI:1073792347
Name:QUIMEN, LEONILA P (PT)
Entity Type:Individual
Prefix:
First Name:LEONILA
Middle Name:P
Last Name:QUIMEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 COBRE CT
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-1240
Mailing Address - Country:US
Mailing Address - Phone:626-818-0886
Mailing Address - Fax:
Practice Address - Street 1:600 W MAIN ST
Practice Address - Street 2:SUITE 107
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3300
Practice Address - Country:US
Practice Address - Phone:626-642-0363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT16156225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT16156Medicare PIN