Provider Demographics
NPI:1669071882
Name:QUINONES, GERARDO SR
Entity type:Individual
Prefix:
First Name:GERARDO
Middle Name:
Last Name:QUINONES
Suffix:SR
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 1:1040 S MOUNT VERNON AVE # G-276
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-4228
Mailing Address - Country:US
Mailing Address - Phone:562-533-8348
Mailing Address - Fax:
Practice Address - Street 1:839 ILLINOIS AVE.
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-9232
Practice Address - Country:US
Practice Address - Phone:562-533-8348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT-00060479246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy