Provider Demographics
NPI:1306392873
Name:QUITALIG, ERNESTO FAUSTO GARCIA JR (NP-C)
Entity Type:Individual
Prefix:
First Name:ERNESTO FAUSTO
Middle Name:GARCIA
Last Name:QUITALIG
Suffix:JR
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29351 CROWN RDG
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7813
Mailing Address - Country:US
Mailing Address - Phone:253-212-5848
Mailing Address - Fax:
Practice Address - Street 1:8316 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-2850
Practice Address - Country:US
Practice Address - Phone:818-273-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60732199363LF0000X
CA95005324363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily