Provider Demographics
NPI:1154895506
Name:QUIJANO, CHRISTIAN (DPT)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:
Last Name:QUIJANO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 CENTRAL AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-6217
Mailing Address - Country:US
Mailing Address - Phone:505-662-3384
Mailing Address - Fax:
Practice Address - Street 1:1350 CENTRAL AVE STE 105
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-6217
Practice Address - Country:US
Practice Address - Phone:505-662-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0015893225100000X
NM5437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist