Provider Demographics
NPI:1508058843
Name:QUANQUIN, NATALIE MICHELE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:MICHELE
Last Name:QUANQUIN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
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Mailing Address - Street 1:10833 LE CONTE AVE
Mailing Address - Street 2:MDCC 22-442
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1752
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10833 LE CONTE AVE
Practice Address - Street 2:MDCC 22-442
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1752
Practice Address - Country:US
Practice Address - Phone:310-825-5235
Practice Address - Fax:310-206-4764
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA105913208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program