Provider Demographics
NPI:1558021154
Name:QUINONES, SAMUEL JASON
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:JASON
Last Name:QUINONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2442 E BEECH AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-1360
Mailing Address - Country:US
Mailing Address - Phone:415-580-5338
Mailing Address - Fax:
Practice Address - Street 1:11517 15TH AVE
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-9508
Practice Address - Country:US
Practice Address - Phone:559-380-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator