MEDICARE: DR. QUIDA DEBORAH DRAINE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171000000X	Military Health Care Provider	G53200	CA

General Provider Information

NPI Number	:	1679667372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. QUIDA DEBORAH DRAINE MD

Provider Business Mailing Address
First Line	:	2740 S BRISTOL ST
Second Line	:	SUITE 110
City	:	SANTA ANA
State	:	CA
Zip	:	92704-6209
Country	:	US
Telephone Number	:	714-825-3500
Fax Number	:	714-825-0246

Provider Business Practice Location Address
First Line	:	2740 S BRISTOL ST
Second Line	:	SUITE 110
City	:	SANTA ANA
State	:	CA
Zip	:	92704-6209
Country	:	US
Telephone Number	:	714-825-3500
Fax Number	:	714-825-0246

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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