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General NPI Number Information
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NPI Number | 1336995737
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Entity Type | Organization
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Legal Business Name | QUANTUM WELLNESS
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Dates
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Enumeration Date | 04/26/2024
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Last Update Date | 04/26/2024
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Provider Practice Location Address
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Address Line | 3418 GOLDBERRY LN
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City | EUGENE
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State | OR
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Zip | 97404-2037
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Country | US
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Telephone | 858-997-7451
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 41153
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City | EUGENE
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State | OR
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Zip | 97404-0306
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Country | US
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Telephone | 858-997-7451
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JORGE CORREA
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Credential | PH.D.
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Telephone | 858-997-7451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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