Healthcare Provider Details

I. General information

NPI: 1174192595
Provider Name (Legal Business Name): JOSEPH QUIAMBAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CONTINENTAL BLVD STE 150
EL SEGUNDO CA
90245-5043
US

IV. Provider business mailing address

300 CONTINENTAL BLVD STE 150
EL SEGUNDO CA
90245-5043
US

V. Phone/Fax

Practice location:
  • Phone: 424-225-1845
  • Fax:
Mailing address:
  • Phone: 424-225-1845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: