Provider Demographics
NPI:1912720244
Name:QUINTUA, PERPETUO MORANTE
Entity type:Individual
Prefix:
First Name:PERPETUO
Middle Name:MORANTE
Last Name:QUINTUA
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 1:2073 VIA MIRAFLORES
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-3733
Mailing Address - Country:US
Mailing Address - Phone:619-939-8989
Mailing Address - Fax:
Practice Address - Street 1:2073 VIA MIRAFLORES
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-3733
Practice Address - Country:US
Practice Address - Phone:619-939-8989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman