Provider Demographics
NPI:1619288172
Name:QUESNELL, TARA ANN (DO)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:ANN
Last Name:QUESNELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:ANN
Other - Last Name:HOLSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6010 HIDDEN VALLEY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-4219
Mailing Address - Country:US
Mailing Address - Phone:760-631-3000
Mailing Address - Fax:760-631-3016
Practice Address - Street 1:6010 HIDDEN VALLEY RD STE 200
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-4219
Practice Address - Country:US
Practice Address - Phone:760-631-3000
Practice Address - Fax:760-631-3016
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A136092084N0600X, 2084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology