Provider Demographics
NPI:1679633507
Name:QUIROS, PETER (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:QUIROS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 FAIRMOUNT AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3150
Mailing Address - Country:US
Mailing Address - Phone:626-817-4701
Mailing Address - Fax:626-817-4702
Practice Address - Street 1:625 S FAIR OAKS AVE
Practice Address - Street 2:SUITE 280
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2613
Practice Address - Country:US
Practice Address - Phone:626-817-4747
Practice Address - Fax:626-817-4748
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA64488207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A644880OtherBLUE SHIELD
CAW11993OtherMEDICARE GROUP# LA OFFICE
CA00A644880Medicaid
CA180040554OtherMEDICARE RAILROAD
CAW11993AOtherMEDICARE GRP# ORANGE OFF
CAZZZ51610ZOtherMEDICARE GRP# PALM SPRING
CAW11993OtherMEDICARE GROUP# LA OFFICE
CA00A644880Medicaid
CAZZZ51610ZOtherMEDICARE GRP# PALM SPRING
CAWA64488AMedicare PIN