Provider Demographics
NPI:1629197439
Name:RUBENCIO QUINTANA, M.D. INC.
Entity type:Organization
Organization Name:RUBENCIO QUINTANA, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUBENCIO
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-659-5500
Mailing Address - Street 1:6310 SAN VICENTE BLVD STE 510
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5470
Mailing Address - Country:US
Mailing Address - Phone:310-659-5500
Mailing Address - Fax:424-269-2166
Practice Address - Street 1:6310 SAN VICENTE BLVD STE 510
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5470
Practice Address - Country:US
Practice Address - Phone:310-659-5500
Practice Address - Fax:424-269-2166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77939261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG02218Medicare UPIN
CAG77939Medicare ID - Type Unspecified