1164536041 NPI number — DR. PHYLLIS QUINTANA OD

Table of content: DR. PHYLLIS QUINTANA OD (NPI 1164536041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164536041 NPI number — DR. PHYLLIS QUINTANA OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUINTANA
Provider First Name:
PHYLLIS
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
QUINTANA
Provider Other First Name:
PHYLLIS
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1164536041
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
907 WEST 7TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OXNARD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-487-0609
Provider Business Mailing Address Fax Number:
805-487-8330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
907 WEST 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXNARD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-487-0609
Provider Business Practice Location Address Fax Number:
805-487-8330
Provider Enumeration Date:
08/18/2006

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: 152W00000X , with the licence number:  5585TPA , 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: 500055850 . This is a "MEDICAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6701 . This is a "MEDICAL EYE SERVICES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6648 . This is a "GOLDEN WEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 953833691 . This is a "VSP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6701 . This is a "NNES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 116524 . This is a "EYE MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 953833691 . This is a "TRI CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 953833691 . This is a "BLUE SHIELD OF CA" identifier . This identifiers is of the category "OTHER".




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