Provider Demographics
NPI:1649363060
Name:QUIJANO, GENEROSO JR (DMD)
Entity type:Individual
Prefix:DR
First Name:GENEROSO
Middle Name:
Last Name:QUIJANO
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2400 WESTBOROUGH BLVD
Mailing Address - Street 2:SUITE 202B
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5404
Mailing Address - Country:US
Mailing Address - Phone:650-871-8485
Mailing Address - Fax:650-871-8486
Practice Address - Street 1:2400 WESTBOROUGH BLVD
Practice Address - Street 2:SUITE 202B
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5404
Practice Address - Country:US
Practice Address - Phone:650-871-8485
Practice Address - Fax:650-871-8486
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA466731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice