Provider Demographics
NPI:1467007690
Name:KOSTIUK-THOMPSON, QUIANA
Entity Type:Individual
Prefix:
First Name:QUIANA
Middle Name:
Last Name:KOSTIUK-THOMPSON
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 1:7415 HENRIETTA DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-5142
Mailing Address - Country:US
Mailing Address - Phone:916-207-3995
Mailing Address - Fax:
Practice Address - Street 1:7415 HENRIETTA DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-5142
Practice Address - Country:US
Practice Address - Phone:916-520-7399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator