Provider Demographics
NPI:1962681023
Name:QUANTOM LEAP
Entity Type:Organization
Organization Name:QUANTOM LEAP
Other - Org Name:QUANTOM LEAP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C E O
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-447-0770
Mailing Address - Street 1:7299 N CHANNING WAY
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-0487
Mailing Address - Country:US
Mailing Address - Phone:559-447-0770
Mailing Address - Fax:559-268-1302
Practice Address - Street 1:22368 S. 6TH
Practice Address - Street 2:
Practice Address - City:SOUTH DOS PALOS
Practice Address - State:CA
Practice Address - Zip Code:93620
Practice Address - Country:US
Practice Address - Phone:559-447-0770
Practice Address - Fax:559-268-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty