1023038312 NPI number — RENEE S QUINTO PH.D.

Table of content: RENEE S QUINTO PH.D. (NPI 1023038312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023038312 NPI number — RENEE S QUINTO PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUINTO
Provider First Name:
RENEE
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SIEMSEN
Provider Other First Name:
RENEE
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023038312
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1687
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKLIN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95677-7687
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-212-8470
Provider Business Mailing Address Fax Number:
916-625-0357

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1329 HOWE AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95825-3363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-212-8470
Provider Business Practice Location Address Fax Number:
916-625-0357
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY16926 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OPL169260 . This is a "BLUE SHIELD PROVIDER NUMB" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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