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General NPI Number Information
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NPI Number | 1275171092
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Entity Type | Organization
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Legal Business Name | QUANTUM GLOBAL HEALTH OF RIVERSIDE
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Dates
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Enumeration Date | 12/11/2019
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Last Update Date | 12/11/2019
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Provider Practice Location Address
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Address Line | 299 W HILLCREST DR STE 104
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-7822
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Country | US
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Telephone | 805-285-7725
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Fax |
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Provider Business Mailing Address
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Address Line | 299 W HILLCREST DR STE 104
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-7822
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COORDINATOR
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Name | PEDRO SANQUE
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Credential |
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Telephone | 805-285-7725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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