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General NPI Number Information
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NPI Number | 1649494931
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Entity Type | Organization
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Legal Business Name | EASTFIELD MING QUONG
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 572 N ARROWHEAD AVE
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City | SAN BERNARDINO
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State | CA
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Zip | 92401-1251
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Country | US
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Telephone | 909-266-2710
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Fax |
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Provider Business Mailing Address
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Address Line | 3425 FIELDCREST CT
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City | PERRIS
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State | CA
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Zip | 92571-7363
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Country | US
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Telephone | 909-781-8974
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Fax |
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Authorized Official
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Title or Position | FAMILY SPECIALIST
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Name | TORRAY KERL
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Credential | BA
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Telephone | 909-781-8974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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