Provider Demographics
NPI:1386083780
Name:QUINTANA, DIANNE ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:ELIZABETH
Last Name:QUINTANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 E RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-7307
Mailing Address - Country:US
Mailing Address - Phone:909-469-9013
Mailing Address - Fax:909-469-9014
Practice Address - Street 1:2680 E RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761
Practice Address - Country:US
Practice Address - Phone:909-469-9013
Practice Address - Fax:909-469-9014
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA132214208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADQ3232267556OtherDQ3232267556