Healthcare Provider Details

I. General information

NPI: 1932867611
Provider Name (Legal Business Name): ZIQIN QU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11895 AVENUE OF INDUSTRY
SAN DIEGO CA
92128-3423
US

IV. Provider business mailing address

5372 W FALLS VIEW DR
SAN DIEGO CA
92115-1426
US

V. Phone/Fax

Practice location:
  • Phone: 858-673-0101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95253444
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: