Healthcare Provider Details

I. General information

NPI: 1972424182
Provider Name (Legal Business Name): QUALITA JOAQUIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: QUALITA TIU RECIDORO NP

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 LA JOLLA VILLAGE DR
SAN DIEGO CA
92161-0002
US

IV. Provider business mailing address

2808 FAYE DR
SAN MARCOS CA
92078-7447
US

V. Phone/Fax

Practice location:
  • Phone: 858-205-3862
  • Fax:
Mailing address:
  • Phone: 858-205-3862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95040692
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: