Provider Demographics
NPI:1942810635
Name:QUINTERO TOVAR, MOISES
Entity Type:Individual
Prefix:
First Name:MOISES
Middle Name:
Last Name:QUINTERO TOVAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 S SAN ANTONIO RD
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1720
Mailing Address - Country:US
Mailing Address - Phone:424-227-0002
Mailing Address - Fax:
Practice Address - Street 1:66 S SAN ANTONIO RD
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93110-1720
Practice Address - Country:US
Practice Address - Phone:424-227-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner