Healthcare Provider Details

I. General information

NPI: 1073862330
Provider Name (Legal Business Name): LAURA QUINTAL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2012
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

505 PARNASSUS AVE
SAN FRANCISCO CA
94143-2204
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7053
  • Fax: 415-885-3637
Mailing address:
  • Phone: 415-353-7053
  • Fax: 415-885-3637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number64349
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: