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NPI Code Detail

MEDICARE: MICHAEL QUACH RN

MEDICARE: MICHAEL QUACH RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse650057CA

General Provider Information

NPI Number : 1417887613
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL QUACH RN
Provider Business Mailing Address
First Line : 13420 PRECIADO AVE
Second Line :
City : CHINO
State : CA
Zip : 91710-4913
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 14677 MERRILL AVE
Second Line :
City : FONTANA
State : CA
Zip : 92335-4219
Country : US
Telephone Number : 951-643-2340
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2026
Last Update Date : 05/27/2026

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