Provider Demographics
NPI:1336377662
Name:QUITORIANO, JOHN PAULO (IDC)
Entity Type:Individual
Prefix:MR
First Name:JOHN PAULO
Middle Name:
Last Name:QUITORIANO
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COMMANDING GENERAL III MARINE EXPEDITIONARY FORCE
Mailing Address - Street 2:UNIT 35601, OKINAWA JAPAN
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96605-5601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:III MARINE EXPEDITIONARY FORCE
Practice Address - Street 2:UNIT 35601
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96605-5601
Practice Address - Country:US
Practice Address - Phone:310-817-4736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman