Healthcare Provider Details

I. General information

NPI: 1821387440
Provider Name (Legal Business Name): ASHLEY QUINN THORBURN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MDG / SGCS 101 BODIN CIR
TRAVIS AFB CA
94535
US

IV. Provider business mailing address

101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

V. Phone/Fax

Practice location:
  • Phone: 707-816-5825
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA170472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: