1710049333 NPI number — MS. ANGELA CATHERINE QUINTANILLA CRNA

Table of content: MS. ANGELA CATHERINE QUINTANILLA CRNA (NPI 1710049333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710049333 NPI number — MS. ANGELA CATHERINE QUINTANILLA CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUINTANILLA
Provider First Name:
ANGELA
Provider Middle Name:
CATHERINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710049333
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2202 S CEDAR ST
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98405-2318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-284-9231
Provider Business Mailing Address Fax Number:
253-284-9241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2202 S CEDAR ST
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405-2318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-830-5432
Provider Business Practice Location Address Fax Number:
253-830-5433
Provider Enumeration Date:
12/14/2006

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: 367500000X , with the licence number:  AP30005547 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X , with the licence number: RN198128 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: ARNP9340888 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: G8913836 . This is a "MDCR PTAN (K)" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: G8919205 . This is a "MDCR PTAN (P)" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".