Provider Demographics
NPI:1538760459
Name:QUINONEZ, CARLOS HERIBERTO (RDHAP, BS)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:HERIBERTO
Last Name:QUINONEZ
Suffix:
Gender:M
Credentials:RDHAP, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16077 CHELLA DR
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6402
Mailing Address - Country:US
Mailing Address - Phone:323-447-5480
Mailing Address - Fax:
Practice Address - Street 1:16077 CHELLA DR
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6402
Practice Address - Country:US
Practice Address - Phone:323-447-5480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA742125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes125K00000XDental ProvidersAdvanced Practice Dental TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA742OtherDENTAL HYGIENE BOARD OF CALIFORNIA
CA742OtherRDHAP