Provider Demographics
NPI:1518195957
Name:QUIJANO FAMILY PRACTICE
Entity Type:Organization
Organization Name:QUIJANO FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:M
Authorized Official - Last Name:QUIJANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-399-7474
Mailing Address - Street 1:PO BOX 12969
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97309-0969
Mailing Address - Country:US
Mailing Address - Phone:503-399-7474
Mailing Address - Fax:503-399-0679
Practice Address - Street 1:608 LANCASTER DR SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97317-5643
Practice Address - Country:US
Practice Address - Phone:503-399-7474
Practice Address - Fax:503-399-0679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty