Provider Demographics
NPI:1093373342
Name:QUINTANA, VANESSA ANTONIA (MSW)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:ANTONIA
Last Name:QUINTANA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 KANSAS ST APT 204
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-1469
Mailing Address - Country:US
Mailing Address - Phone:909-963-6503
Mailing Address - Fax:
Practice Address - Street 1:4164 BROCKTON AVE STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3400
Practice Address - Country:US
Practice Address - Phone:951-888-1346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-02
Last Update Date:2019-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical