MEDICARE: MICHAEL QUAN

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	106E00000X	Assistant Behavior Analyst	0178305

General Provider Information

NPI Number	:	1891202057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL QUAN

Provider Business Mailing Address
First Line	:	2730 SHADELANDS DR BLDG 10
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94598-2538
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5601 ARNOLD RD FL 104
Second Line	:
City	:	DUBLIN
State	:	CA
Zip	:	94568-7726
Country	:	US
Telephone Number	:	925-266-8023
Fax Number	:

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

Provider Enumeration Date	:	01/09/2018
Last Update Date	:	03/29/2022

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