Provider Demographics
NPI:1285445817
Name:QUINALTY, RILEY JESSE
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:JESSE
Last Name:QUINALTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1752 E. LUGONIA AVE STE 117 - 1094
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399
Mailing Address - Country:US
Mailing Address - Phone:951-880-5869
Mailing Address - Fax:
Practice Address - Street 1:1752 E LUGONIA AVE STE 1171094
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2730
Practice Address - Country:US
Practice Address - Phone:909-654-6798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician