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General NPI Number Information
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NPI Number | 1679420160
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Entity Type | Organization
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Legal Business Name | QUANTUM PROVIDER SOLUTIONS LLC
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Dates
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Enumeration Date | 03/13/2026
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Last Update Date | 03/13/2026
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Provider Practice Location Address
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Address Line | 10 W BROADWAY FL 7
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City | SALT LAKE CITY
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State | UT
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Zip | 84101-2060
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Country | US
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Telephone | 323-251-7313
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Fax |
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Provider Business Mailing Address
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Address Line | 10 W BROADWAY
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City | SALT LAKE CITY
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State | UT
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Zip | 84101-2002
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Country | US
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Telephone | 323-251-7313
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | SIRAJE KAKOOZA
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Credential |
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Telephone | 323-251-7313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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