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General NPI Number Information
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NPI Number | 1376922617
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Entity Type | Organization
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Legal Business Name | LOVINGLY QUITANIA PARK, PH.D.
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Dates
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Enumeration Date | 05/19/2015
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Last Update Date | 05/19/2015
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Provider Practice Location Address
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Address Line | 1560 E CHEVY CHASE DR
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City | GLENDALE
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State | CA
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Zip | 91206-4197
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Country | US
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Telephone | 818-800-8697
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1292
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City | LA CANADA
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State | CA
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Zip | 91012-5292
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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 | NEUROPSYCHOLOGIST
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Name | DR. LOVINGLY QUITANIA PARK
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Credential | PHD
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Telephone | 818-800-8697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PSY25525
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License Number State | CA
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