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General NPI Number Information
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NPI Number | 1922270180
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Entity Type | Organization
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Legal Business Name | QUANTUM HEALTH MEDICAL GROUP INC
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 12430 VIARNA ST
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City | CERRITOS
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State | CA
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Zip | 90703-7731
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Country | US
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Telephone | 562-547-9479
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Fax |
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Provider Business Mailing Address
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Address Line | 13337 SOUTH ST #595
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City | CERRITOS
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State | CA
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Zip | 90703-7308
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Country | US
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Telephone | 562-547-9479
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LEONARDO PEREZ
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Credential | PA-C
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Telephone | 562-547-9479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 36917
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License Number State | CA
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