Healthcare Provider Details

I. General information

NPI: 1043379985
Provider Name (Legal Business Name): QUINT SKIPTON P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W BASTANCHURY RD SUITE 210
FULLERTON CA
92835-3419
US

IV. Provider business mailing address

3851 KATELLA AVE STE 105
LOS ALAMITOS CA
90720-3389
US

V. Phone/Fax

Practice location:
  • Phone: 714-879-9936
  • Fax: 714-879-3035
Mailing address:
  • Phone: 562-799-3330
  • Fax: 562-799-3399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14713
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: