Basic Information
| Provider Information | |||||||||
| NPI: | 1982218160 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUIOCHO | ||||||||
| FirstName: | RUBEN | ||||||||
| MiddleName: | DELA CRUZ | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8543 ASPECT DR | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921082637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4085040147 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4309 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921031407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6198764502 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2020 | ||||||||
| LastUpdateDate: | 09/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 243800 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.