Provider Demographics
NPI:1124585500
Name:QUINTANA, CESAR
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:
Last Name:QUINTANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:864 N MORGAN ST APT B
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-4513
Mailing Address - Country:US
Mailing Address - Phone:714-737-1494
Mailing Address - Fax:
Practice Address - Street 1:7177 BROCKTON AVE STE 444
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2635
Practice Address - Country:US
Practice Address - Phone:951-234-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANONEOtherSTOP FUNDED