Provider Demographics
NPI:1720068976
Name:QUINTANA, RICHARD DALE (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DALE
Last Name:QUINTANA
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 1:91-1042 AAWA DR
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3900
Mailing Address - Country:US
Mailing Address - Phone:925-765-0873
Mailing Address - Fax:
Practice Address - Street 1:15TH MEDICAL GROUP
Practice Address - Street 2:HICKAM AFB
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96853
Practice Address - Country:US
Practice Address - Phone:925-765-0873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG077257207Q00000X
HIMD-10029207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine