Healthcare Provider Details

I. General information

NPI: 1609592252
Provider Name (Legal Business Name): QUICLINICS MEDICAL PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/17/2022
Certification Date: 10/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N D ST STE 306
SAN BERNARDINO CA
92401-1545
US

IV. Provider business mailing address

5319 UNIVERSITY DR STE 232
IRVINE CA
92612-2965
US

V. Phone/Fax

Practice location:
  • Phone: 949-786-2004
  • Fax:
Mailing address:
  • Phone: 949-786-2004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JAY FRANCIS LAMOTHE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 949-786-2004