Provider Demographics
NPI:1518708015
Name:QUINTANA VEGA, ANNIE (NP)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:QUINTANA VEGA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S GLENDORA AVE UNIT 1347
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-5903
Mailing Address - Country:US
Mailing Address - Phone:786-603-9792
Mailing Address - Fax:
Practice Address - Street 1:301 S GLENDORA AVE UNIT 1347
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-5903
Practice Address - Country:US
Practice Address - Phone:786-603-9792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030395363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner