Healthcare Provider Details

I. General information

NPI: 1588902142
Provider Name (Legal Business Name): EDWARD JAMES QUILLIGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 12/28/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GOLDENGLOW ST
IRVINE CA
92612-2220
US

IV. Provider business mailing address

1 GOLDENGLOW ST
IRVINE CA
92612-2220
US

V. Phone/Fax

Practice location:
  • Phone: 949-246-8452
  • Fax: 949-854-7094
Mailing address:
  • Phone: 949-246-8452
  • Fax: 949-854-7094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC27023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: