Provider Demographics
NPI:1457669384
Name:QUINTEROS, DAVID JOSE (MSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JOSE
Last Name:QUINTEROS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:JOSE
Other - Last Name:MADRID-QUINTEROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1650 E OLD BADILLO ST
Mailing Address - Street 2:# B3
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3163
Mailing Address - Country:US
Mailing Address - Phone:323-313-4053
Mailing Address - Fax:
Practice Address - Street 1:1126 N GRAND AVE STE D
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-1552
Practice Address - Country:US
Practice Address - Phone:909-967-1667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA744381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical