Healthcare Provider Details

I. General information

NPI: 1699973115
Provider Name (Legal Business Name): FLORIZZA QUILALA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 BAKER ST SUITE 100
COSTA MESA CA
92626-4108
US

IV. Provider business mailing address

PO BOX 15277
NEWPORT BEACH CA
92659-5277
US

V. Phone/Fax

Practice location:
  • Phone: 714-668-2540
  • Fax: 714-668-2510
Mailing address:
  • Phone: 714-668-2540
  • Fax: 949-668-2510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA67983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: