Healthcare Provider Details

I. General information

NPI: 1750237103
Provider Name (Legal Business Name): QUANTUM BLUE NURSING, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 W 39TH ST APT 3
SAN PEDRO CA
90731-7040
US

IV. Provider business mailing address

491 W 39TH ST APT 3
SAN PEDRO CA
90731-7040
US

V. Phone/Fax

Practice location:
  • Phone: 424-505-0486
  • Fax: 424-999-0390
Mailing address:
  • Phone: 424-505-0486
  • Fax: 424-999-0390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: GRETCHEN GENATO
Title or Position: PRESIDENT
Credential: PMHNP-BC
Phone: 424-505-0486