Provider Demographics
NPI:1588837843
Name:QUIETTE, ANTHONY JEROME
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JEROME
Last Name:QUIETTE
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 1:200 W COMPTON BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-6676
Mailing Address - Country:US
Mailing Address - Phone:310-603-7919
Mailing Address - Fax:310-603-7651
Practice Address - Street 1:200 W COMPTON BLVD
Practice Address - Street 2:STE 300
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-6676
Practice Address - Country:US
Practice Address - Phone:310-603-7919
Practice Address - Fax:310-603-7651
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator