Provider Demographics
NPI:1104951326
Name:QUAN, TRISHA RAE (MAT, ATC,)
Entity type:Individual
Prefix:MS
First Name:TRISHA
Middle Name:RAE
Last Name:QUAN
Suffix:
Gender:F
Credentials:MAT, ATC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3653
Mailing Address - Country:US
Mailing Address - Phone:415-197-5585
Mailing Address - Fax:
Practice Address - Street 1:395 DOHERTY DR
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1536
Practice Address - Country:US
Practice Address - Phone:415-945-3619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer