Provider Demographics
NPI:1104049949
Name:QUINTERO, GERI L (LAC)
Entity type:Individual
Prefix:MS
First Name:GERI
Middle Name:L
Last Name:QUINTERO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 232
Mailing Address - Street 2:
Mailing Address - City:FORT JONES
Mailing Address - State:CA
Mailing Address - Zip Code:96032-0232
Mailing Address - Country:US
Mailing Address - Phone:530-468-5727
Mailing Address - Fax:
Practice Address - Street 1:335 N MAIN ST
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-2539
Practice Address - Country:US
Practice Address - Phone:530-842-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6226171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist