Healthcare Provider Details

I. General information

NPI: 1114531035
Provider Name (Legal Business Name): Q & M PHYSICIAN MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 07/30/2022
Certification Date: 07/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 KENDALL DR STE C
SAN BERNARDINO CA
92407-4156
US

IV. Provider business mailing address

941 KENDALL DR STE C
SAN BERNARDINO CA
92407-4156
US

V. Phone/Fax

Practice location:
  • Phone: 951-316-8406
  • Fax:
Mailing address:
  • Phone: 909-726-3200
  • Fax: 909-726-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: QUYEN T DESPAS
Title or Position: OWNER
Credential:
Phone: 714-397-0706