Provider Demographics
NPI:1629161245
Name:CRUCIGER, QUITA V (MD)
Entity Type:Individual
Prefix:DR
First Name:QUITA
Middle Name:V
Last Name:CRUCIGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 WEBSTER STREET
Mailing Address - Street 2:SUITE 428
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115
Mailing Address - Country:US
Mailing Address - Phone:415-923-3115
Mailing Address - Fax:415-474-8273
Practice Address - Street 1:2100 WEBSTER STREET
Practice Address - Street 2:SUITE 428
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115
Practice Address - Country:US
Practice Address - Phone:415-923-3115
Practice Address - Fax:415-474-8273
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC39413207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A37141Medicare UPIN
00C394130Medicare ID - Type Unspecified