Healthcare Provider Details

I. General information

NPI: 1477538700
Provider Name (Legal Business Name): KIRSTEN QUITNO JULIET M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIRSTEN QUITNO WHELAN M.D.

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 HOSPITAL DR
UKIAH CA
95482-4533
US

IV. Provider business mailing address

PO BOX 2739
UKIAH CA
95482-2739
US

V. Phone/Fax

Practice location:
  • Phone: 707-463-8000
  • Fax: 707-462-1111
Mailing address:
  • Phone: 707-463-8000
  • Fax: 707-462-1111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA67729
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: