Basic Information
| Provider Information | |||||||||
| NPI: | 1073511432 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUINTERO | ||||||||
| FirstName: | RICARDO | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18000 STUDEBAKER RD STE 800 | ||||||||
| Address2: | |||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907032671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627353226 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 18000 STUDEBAKER RD STE 800 | ||||||||
| Address2: | |||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907032671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627353226 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2005 | ||||||||
| LastUpdateDate: | 04/23/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 09/29/2005 | ||||||||
| NPIReactivationDate: | 11/01/2006 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | C161493 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | E7051S | 01 | FL | MEDICARE | OTHER | P01462033 | 01 | FL | RAILROAD MEDICARE | OTHER | 1087226 | 01 | FL | WELLCARE | OTHER | 17336 | 01 | FL | BCBS | OTHER | 7234314 | 01 | FL | AETNA | OTHER | PRV0010410 | 01 | FL | PREFFERED MEDICAL PLAN | OTHER | 264422300 | 05 | FL | MEDICAID | 4468097 | 01 | FL | CONCENTRA/FOCUS THRU KEYS PHA | OTHER | 330467 | 01 | FL | AVMED | OTHER | 4171740 | 01 | FL | CIGNA/GREAT WEST | OTHER |