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General NPI Number Information
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NPI Number | 1386354447
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Entity Type | Organization
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Legal Business Name | QUADRANT CA VIRTUAL PEDIATRIC MEDICAL CARE PC
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Dates
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Enumeration Date | 11/30/2022
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 1100 W TOWN AND COUNTRY RD STE 1250
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City | ORANGE
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State | CA
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Zip | 92868-4633
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Country | US
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Telephone | 866-219-8595
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 34464
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City | BELFAST
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State | ME
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Zip | 04915-0622
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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 | SOLE SHAREHOLDER
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Name | DAVID TRAVER
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Credential |
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Telephone | 650-520-8485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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