Provider Demographics
NPI:1902091309
Name:QUINONEZ, RAFAEL EDUARDO (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:EDUARDO
Last Name:QUINONEZ
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11550 INDIAN HILLS RD STE 280
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1244
Mailing Address - Country:US
Mailing Address - Phone:818-361-5069
Mailing Address - Fax:818-837-3411
Practice Address - Street 1:11550 INDIAN HILLS RD STE 280
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1244
Practice Address - Country:US
Practice Address - Phone:818-361-5069
Practice Address - Fax:818-837-3411
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-09
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101502207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA101502Medicare PIN