=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285867994
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUALITY HEALTHCARE SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2009
-----------------------------------------------------
Last Update Date | 08/27/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14482 BEACH BLVD STE R
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92683-5341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-724-7722
-----------------------------------------------------
Fax | 714-889-7254
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14482 BEACH BLVD STE R
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92683-5341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-724-7722
-----------------------------------------------------
Fax | 714-889-7254
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/PROVIDER
-----------------------------------------------------
Name | DR. KENNETH MASON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 714-724-7722
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | G53438
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------