Basic Information
Provider Information
NPI: 1598853277
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: QUINTOS
FirstName: ARLYN
MiddleName: G
NamePrefix: MRS.
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11234 ANDERSON ST
Address2: PO BOX 2000
City: LOMA LINDA
State: CA
PostalCode: 923542804
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 11234 ANDERSON ST
Address2:  
City: LOMA LINDA
State: CA
PostalCode: 923542804
CountryCode: US
TelephoneNumber: 9095588514
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/10/2006
LastUpdateDate: 01/15/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X13447CAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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