Healthcare Provider Details

I. General information

NPI: 1821740945
Provider Name (Legal Business Name): JOEL QUITUGUA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3906 WABASH AVE UNIT C
SAN DIEGO CA
92104-2121
US

IV. Provider business mailing address

PO BOX 882258
SAN DIEGO CA
92168-2258
US

V. Phone/Fax

Practice location:
  • Phone: 808-379-8383
  • Fax:
Mailing address:
  • Phone: 808-379-8383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95024042
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95212031
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: