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NPI Code Detail

MEDICARE: MISTY QUIAMBAO

MEDICARE: MISTY QUIAMBAO
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
1106S00000XBehavior TechnicianCA

General Provider Information

NPI Number : 1871094292
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISTY QUIAMBAO
Provider Business Mailing Address
First Line : 21600 OXNARD ST STE 1800
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-7807
Country : US
Telephone Number : 818-345-2345
Fax Number :
Provider Business Practice Location Address
First Line : 5352 LAUREL CANYON BLVD STE 100
Second Line :
City : VALLEY VILLAGE
State : CA
Zip : 91607-4923
Country : US
Telephone Number : 747-254-1154
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2018
Last Update Date : 02/21/2018

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Directions to “ MISTY QUIAMBAO ” Practice Location

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