Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 35.134815 | OH |
N | 207QA0505X | Family Doctor - Adult Medicine | A158027 | CA |
NPI | 1235583410 |
---|---|
Provider Name | Joel Quijano |
First Address | San Bernardino, CA 92423-0069 |
Second Address | Redlands, CA 92373-5916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2016 |
Last Update Date | 22/08/2019 |