Provider Demographics
NPI:1568968899
Name:QUEMUEL, CONRADO OLALIA (CRT)
Entity Type:Individual
Prefix:MR
First Name:CONRADO
Middle Name:OLALIA
Last Name:QUEMUEL
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 E 1ST ST STE 900
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-4066
Mailing Address - Country:US
Mailing Address - Phone:714-474-1149
Mailing Address - Fax:
Practice Address - Street 1:242 PREBLE DR
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3720
Practice Address - Country:US
Practice Address - Phone:714-474-1149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHF000974082471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHF00097408OtherSTATE OF CALIFORNIA RADIOLOGIC TECHNOLOGIST LICENSE