Healthcare Provider Details

I. General information

NPI: 1205831799
Provider Name (Legal Business Name): PAULINA M DEQUIROZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 N. PALO VERDE
LONG BEACH CA
90815
US

IV. Provider business mailing address

1665 SCENIC AVE. SUITE 100
COSTA MESA CA
92626
US

V. Phone/Fax

Practice location:
  • Phone: 714-442-4864
  • Fax: 714-442-4892
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA29803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: