Provider Demographics
NPI:1063931020
Name:QUITASOL, PETER ALLAN AVILA (MD)
Entity type:Individual
Prefix:DR
First Name:PETER ALLAN
Middle Name:AVILA
Last Name:QUITASOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 GENERAL LUNA ST NOTRE DAME DE CHARTRES HOSPITAL
Mailing Address - Street 2:RM 208 PUEBLO DE MARIA BLDG
Mailing Address - City:BAGUIO CITY
Mailing Address - State:BENGUET
Mailing Address - Zip Code:02600
Mailing Address - Country:PH
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 GEN. LUNA ST. NOTRE DAME DE CHARTRES HOSPITAL
Practice Address - Street 2:RM 208 PUEBLO DE MARIA BLDG
Practice Address - City:BAGUIO CITY
Practice Address - State:BENGUET
Practice Address - Zip Code:02600
Practice Address - Country:PH
Practice Address - Phone:074-424-3361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program