Individual
CARL REQUINTINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11060 REMINGTON CT, ADELANTO, CA 92301-6138
(909) 549-3815
Mailing address
11060 REMINGTON CT, ADELANTO, CA 92301-6138
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
09/29/2021
Last updated
09/29/2021
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