Provider Demographics
NPI:1538283080
Name:QUINTANILLA, RIGO (RTC)
Entity Type:Individual
Prefix:
First Name:RIGO
Middle Name:
Last Name:QUINTANILLA
Suffix:
Gender:M
Credentials:RTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8105 PRAIRIE HILLS CT
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-4413
Mailing Address - Country:US
Mailing Address - Phone:916-876-9361
Mailing Address - Fax:
Practice Address - Street 1:9601 KIEFER BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-3818
Practice Address - Country:US
Practice Address - Phone:916-875-5150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist