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General NPI Number Information
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NPI Number | 1790178416
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Entity Type | Organization
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Legal Business Name | QUALITY MEDICAL FOR HOPE, INC
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 03/05/2015
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Provider Practice Location Address
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Address Line | 151 N SUNRISE AVE SUITE 611
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City | ROSEVILLE
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State | CA
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Zip | 95661-2924
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Country | US
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Telephone | 916-784-1050
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Fax | 916-784-1989
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Provider Business Mailing Address
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Address Line | PO BOX 460
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City | ROSEVILLE
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State | CA
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Zip | 95678-0460
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Country | US
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Telephone | 916-784-1050
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Fax | 916-784-1989
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Authorized Official
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Title or Position | CEO
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Name | DONALD R PETERSON II
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Credential | MD
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Telephone | 916-784-1050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | G22928
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License Number State | CA
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