Provider Demographics
NPI:1427556539
Name:QUINN, MAGGIE BETH (ND)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:BETH
Last Name:QUINN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E EL PORTAL APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-3960
Mailing Address - Country:US
Mailing Address - Phone:612-205-0339
Mailing Address - Fax:
Practice Address - Street 1:1202 BRISTOL ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-8605
Practice Address - Country:US
Practice Address - Phone:714-424-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath