Provider Demographics
NPI:1902024045
Name:QUINONEZ, OLIVIA M (COUNSELOR)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:M
Last Name:QUINONEZ
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 W RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-4412
Mailing Address - Country:US
Mailing Address - Phone:310-609-2303
Mailing Address - Fax:310-609-2403
Practice Address - Street 1:1315 N BULLIS RD
Practice Address - Street 2:SUITE 12
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-1650
Practice Address - Country:US
Practice Address - Phone:310-609-2303
Practice Address - Fax:310-609-2403
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor