Healthcare Provider Details

I. General information

NPI: 1609987510
Provider Name (Legal Business Name): STEWART QUISLING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 TULLY RD D-2
MODESTO CA
95350-0838
US

IV. Provider business mailing address

220 STANDIFORD AVE SUITE F
MODESTO CA
95350-1159
US

V. Phone/Fax

Practice location:
  • Phone: 209-523-5195
  • Fax: 209-523-5197
Mailing address:
  • Phone: 209-579-5628
  • Fax: 209-579-5637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberC323000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: