Healthcare Provider Details

I. General information

NPI: 1215031208
Provider Name (Legal Business Name): CHARLES FREDERICK QUEST JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 JOHNSTON ST
HALF MOON BAY CA
94019
US

IV. Provider business mailing address

416 JOHNSTON ST
HALF MOON BAY CA
94019
US

V. Phone/Fax

Practice location:
  • Phone: 650-726-0409
  • Fax: 650-726-0408
Mailing address:
  • Phone: 650-726-0409
  • Fax: 650-726-0408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number00C339720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: