Healthcare Provider Details

I. General information

NPI: 1881224160
Provider Name (Legal Business Name): QUACINELLA ORTHOPAEDICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 10/22/2023
Certification Date: 10/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 FOURTH AVE STE 630
SAN DIEGO CA
92103-2118
US

IV. Provider business mailing address

4060 FOURTH AVE STE 630
SAN DIEGO CA
92103-2118
US

V. Phone/Fax

Practice location:
  • Phone: 619-299-3950
  • Fax:
Mailing address:
  • Phone: 831-239-4736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL QUACINELLA
Title or Position: CEO
Credential: DO, MPH
Phone: 831-239-4736