Provider Demographics
NPI:1922995992
Name:QUINTERO, NICHOLIE KIM
Entity type:Individual
Prefix:
First Name:NICHOLIE
Middle Name:KIM
Last Name:QUINTERO
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 1:4263 BUCKINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-6926
Mailing Address - Country:US
Mailing Address - Phone:626-228-5744
Mailing Address - Fax:626-228-5744
Practice Address - Street 1:4263 BUCKINGHAM AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-6926
Practice Address - Country:US
Practice Address - Phone:626-228-5744
Practice Address - Fax:626-228-5744
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-21
Last Update Date:2025-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50954225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty