Provider Demographics
NPI:1275171092
Name:QUANTUM GLOBAL HEALTH OF RIVERSIDE
Entity Type:Organization
Organization Name:QUANTUM GLOBAL HEALTH OF RIVERSIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-285-7725
Mailing Address - Street 1:299 W HILLCREST DR STE 104
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-7822
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:299 W HILLCREST DR STE 104
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-7822
Practice Address - Country:US
Practice Address - Phone:805-285-7725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty