Provider Demographics
NPI:1447432729
Name:QUINTANILLA, GABRIEL PAUL
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:PAUL
Last Name:QUINTANILLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ADVANCED
Other - Middle Name:
Other - Last Name:HOMECARE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:27349 JEFFERSON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5611
Mailing Address - Country:US
Mailing Address - Phone:951-699-2451
Mailing Address - Fax:951-699-2453
Practice Address - Street 1:27349 JEFFERSON AVE STE 100
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5611
Practice Address - Country:US
Practice Address - Phone:800-758-7571
Practice Address - Fax:888-223-1049
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5553650001Medicare NSC