Provider Demographics
NPI:1831113356
Name:QUIJADA, OCTAVIUS C (MD)
Entity Type:Individual
Prefix:
First Name:OCTAVIUS
Middle Name:C
Last Name:QUIJADA
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 1:101 S FIRST ST
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1928
Mailing Address - Country:US
Mailing Address - Phone:818-845-6206
Mailing Address - Fax:818-845-9774
Practice Address - Street 1:18300 HWY 18
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2206
Practice Address - Country:US
Practice Address - Phone:760-242-2311
Practice Address - Fax:760-242-9167
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25137207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A251370Medicaid
A24297Medicare UPIN
CAA25137Medicare ID - Type Unspecified