Healthcare Provider Details

I. General information

NPI: 1669306320
Provider Name (Legal Business Name): QUANTESSA BELINDA WILEY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 S GRAND AVE
LOS ANGELES CA
90007-3303
US

IV. Provider business mailing address

2651 S MANHATTAN PL APT 103
LOS ANGELES CA
90018-2624
US

V. Phone/Fax

Practice location:
  • Phone: 213-699-1105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: