Provider Demographics
NPI:1407407083
Name:QUIMPO, MARIA NINA FENIZA
Entity Type:Individual
Prefix:
First Name:MARIA NINA
Middle Name:FENIZA
Last Name:QUIMPO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12041 BERTHA ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-7556
Mailing Address - Country:US
Mailing Address - Phone:562-924-7755
Mailing Address - Fax:
Practice Address - Street 1:12041 BERTHA ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-7556
Practice Address - Country:US
Practice Address - Phone:562-924-7755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012890363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily