Provider Demographics
NPI:1821740945
Name:QUITUGUA, JOEL (APRN)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:QUITUGUA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 882258
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92168-2258
Mailing Address - Country:US
Mailing Address - Phone:808-379-8383
Mailing Address - Fax:
Practice Address - Street 1:3906 WABASH AVE UNIT C
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-2121
Practice Address - Country:US
Practice Address - Phone:808-379-8383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95212031163W00000X
CA95024042363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse