Provider Demographics
NPI:1518032762
Name:RONQUILLO, MARIA D (NP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:D
Last Name:RONQUILLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 S ATLANTIC BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-6706
Mailing Address - Country:US
Mailing Address - Phone:213-483-4500
Mailing Address - Fax:213-483-4522
Practice Address - Street 1:850 S ATLANTIC BLVD STE 202
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-6706
Practice Address - Country:US
Practice Address - Phone:213-483-4500
Practice Address - Fax:213-483-4522
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP13432363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0064560Medicaid
CAGR0064560Medicaid