Provider Demographics
NPI:1477631661
Name:FAURIA, QUINN MARTIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:QUINN
Middle Name:MARTIN
Last Name:FAURIA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18433 ROSCOE BLVD STE 214
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4123
Mailing Address - Country:US
Mailing Address - Phone:818-623-4455
Mailing Address - Fax:818-985-0055
Practice Address - Street 1:18433 ROSCOE BLVD STE 214
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4123
Practice Address - Country:US
Practice Address - Phone:818-623-4455
Practice Address - Fax:818-985-0055
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4140213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGRE001960Medicaid
CAWE4140DMedicare PIN
CAU72339Medicare UPIN
CAWE4140EMedicare PIN
CA000E41402Medicare PIN
CAGRE001960Medicaid