Provider Demographics
NPI:1760595078
Name:QUILLIN, WILLIAM HENRY (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:HENRY
Last Name:QUILLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 FOURTH AVE
Mailing Address - Street 2:#409
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910
Mailing Address - Country:US
Mailing Address - Phone:619-585-1811
Mailing Address - Fax:619-585-9587
Practice Address - Street 1:450 FOURTH AVE
Practice Address - Street 2:#409
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910
Practice Address - Country:US
Practice Address - Phone:619-585-1811
Practice Address - Fax:619-585-9587
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG24195207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G241950Medicaid
CA00G241950Medicaid
CAG24195Medicare ID - Type Unspecified