Provider Demographics
NPI:1871513531
Name:QUINTANAR, ROSALI TOSHIKO (OD)
Entity type:Individual
Prefix:DR
First Name:ROSALI
Middle Name:TOSHIKO
Last Name:QUINTANAR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5153 HOLT BLVD
Mailing Address - Street 2:STE A6
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763
Mailing Address - Country:US
Mailing Address - Phone:909-624-3024
Mailing Address - Fax:909-482-4596
Practice Address - Street 1:5153 HOLT BLVD STE A6
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-4837
Practice Address - Country:US
Practice Address - Phone:909-624-3024
Practice Address - Fax:909-482-4596
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT8953TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0089530Medicaid
CASD0089530Medicaid
CA559083997Medicare ID - Type Unspecified
CASD0089530Medicare PIN