Provider Demographics
NPI:1558834283
Name:QUINTERO, VICTORIA ALEXIS
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ALEXIS
Last Name:QUINTERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2453 CITRUS VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-3573
Mailing Address - Country:US
Mailing Address - Phone:626-461-2001
Mailing Address - Fax:
Practice Address - Street 1:3629 SANTA ANITA AVE STE 201
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-3635
Practice Address - Country:US
Practice Address - Phone:626-993-3004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No171M00000XOther Service ProvidersCase Manager/Care Coordinator