Healthcare Provider Details

I. General information

NPI: 1265695811
Provider Name (Legal Business Name): NICHOLE AMBER QUICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7212 ORANGETHORPE AVE STE 9A
BUENA PARK CA
90621-4668
US

IV. Provider business mailing address

7212 ORANGETHORPE AVE STE 9A
BUENA PARK CA
90621-4668
US

V. Phone/Fax

Practice location:
  • Phone: 714-527-6551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number8185054-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberA109598
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberA109598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: