Provider Demographics
NPI:1740427012
Name:QUINTANA, AL JOSE (PA-C)
Entity Type:Individual
Prefix:
First Name:AL
Middle Name:JOSE
Last Name:QUINTANA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4815
Mailing Address - Country:US
Mailing Address - Phone:909-882-2266
Mailing Address - Fax:909-881-7593
Practice Address - Street 1:900 E WASHINGTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-7111
Practice Address - Country:US
Practice Address - Phone:909-882-5867
Practice Address - Fax:909-503-1913
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20123363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA20123OtherCA LICENSE