Provider Demographics
NPI:1346538691
Name:QUILL, PATRICK BRIAN (SOIDC)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:BRIAN
Last Name:QUILL
Suffix:
Gender:M
Credentials:SOIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 555341
Mailing Address - Street 2:1ST MARINE SPECIAL OPERATIONS BN. MEDICAL
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92055-5341
Mailing Address - Country:US
Mailing Address - Phone:760-725-5298
Mailing Address - Fax:
Practice Address - Street 1:553A HOWARD LN
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-2556
Practice Address - Country:US
Practice Address - Phone:714-944-4469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman