Basic Information
| Provider Information | |||||||||
| NPI: | 1861667164 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUINONES | ||||||||
| FirstName: | MANUEL | ||||||||
| MiddleName: | JAIME | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 PACIFIC COAST HIGHWAY | ||||||||
| Address2: | SUITE 181 | ||||||||
| City: | REDONDO BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149951000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 800 PACIFIC COAST HIGHWAY | ||||||||
| Address2: | SUITE 181 | ||||||||
| City: | REDONDO BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149951000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2008 | ||||||||
| LastUpdateDate: | 05/19/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | G48973 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RE0101X | G48973 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.