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General NPI Number Information
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NPI Number | 1265916092
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Entity Type | Individual
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Provider Name | MR. JOHN BRUCE QUANTRILLE
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Gender | Male
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Dates
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Enumeration Date | 09/18/2018
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Last Update Date | 09/18/2018
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Provider Practice Location Address
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Address Line | 555 ARLETTE ARLETTE LANE
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City | DIAMOND SPRINGS
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State | CA
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Zip | 95619
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Country | US
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Telephone | 530-391-1488
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Fax |
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Provider Business Mailing Address
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Address Line | 7777 GREENBACK LN STE 208
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City | CITRUS HEIGHTS
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State | CA
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Zip | 95610-5800
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Country | US
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Telephone | 760-754-9020
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 273055
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License Number State | CA
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