Provider Demographics
NPI:1902179757
Name:ALFREDO QUINONEZ M.D., INC
Entity Type:Organization
Organization Name:ALFREDO QUINONEZ M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINONEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-239-9675
Mailing Address - Street 1:250 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-6832
Mailing Address - Country:US
Mailing Address - Phone:619-236-9675
Mailing Address - Fax:800-804-1187
Practice Address - Street 1:250 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-6832
Practice Address - Country:US
Practice Address - Phone:619-236-9675
Practice Address - Fax:800-804-1187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC35572Medicare UPIN