Provider Demographics
NPI:1568194728
Name:QUILICI, GARRETT ROY
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:ROY
Last Name:QUILICI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HINGHAM SQ
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6403
Mailing Address - Country:US
Mailing Address - Phone:916-983-2753
Mailing Address - Fax:
Practice Address - Street 1:1400 MARKET ST STE 8103
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1050
Practice Address - Country:US
Practice Address - Phone:530-246-5854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program