Provider Demographics
NPI:1306014758
Name:EDQUILANG, EMILIO CHAN JR
Entity Type:Individual
Prefix:MR
First Name:EMILIO
Middle Name:CHAN
Last Name:EDQUILANG
Suffix:JR
Gender:M
Credentials:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34425 FARENHOLT AVENUE
Mailing Address - Street 2:SUITE 40, BLDG. 26-2B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-7040
Mailing Address - Country:US
Mailing Address - Phone:619-532-7141
Mailing Address - Fax:619-532-7337
Practice Address - Street 1:34425 FARENHOLT AVENUE
Practice Address - Street 2:SUITE 40, BLDG. 26-2B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-7040
Practice Address - Country:US
Practice Address - Phone:619-532-7141
Practice Address - Fax:619-532-7337
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTA35936246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist