Healthcare Provider Details

I. General information

NPI: 1629151287
Provider Name (Legal Business Name): MARION A QUINN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E GREEN ST #164
PASADENA CA
91106
US

IV. Provider business mailing address

960 E GREEN ST #164
PASADENA CA
91106
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-7790
  • Fax: 626-793-9018
Mailing address:
  • Phone: 626-793-7790
  • Fax: 626-793-9018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG26112
License Number StateCA

VIII. Authorized Official

Name: DR. MARION A QUINN
Title or Position: OWNER
Credential: MD
Phone: 626-793-7790