Healthcare Provider Details

I. General information

NPI: 1164141578
Provider Name (Legal Business Name): JOSIE PANTALEON QUINN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOSIE PANTALEON

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 DISTRICT CENTER DR
PALM SPRINGS CA
92264-3626
US

IV. Provider business mailing address

35325 DATE PALM DR STE 122
CATHEDRAL CITY CA
92234-7030
US

V. Phone/Fax

Practice location:
  • Phone: 760-883-2700
  • Fax:
Mailing address:
  • Phone: 909-252-7607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: