Provider Demographics
NPI:1275279317
Name:LUNDQUIST, PATRICIA J
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:LUNDQUIST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27472 PORTOLA PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-2853
Mailing Address - Country:US
Mailing Address - Phone:949-239-7582
Mailing Address - Fax:
Practice Address - Street 1:23 CORPORATE PLAZA DR STE 150
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7908
Practice Address - Country:US
Practice Address - Phone:949-393-8662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA126634106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA29133OtherSTATE LICENSE