Provider Demographics
NPI:1184409450
Name:QUILTED HEALTH CALIFORNIA PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:QUILTED HEALTH CALIFORNIA PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & SHAREHOLDER
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENYOUNES
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, CNM
Authorized Official - Phone:703-531-9541
Mailing Address - Street 1:1329 N 47TH ST UNIT 31112
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6787
Mailing Address - Country:US
Mailing Address - Phone:310-367-0355
Mailing Address - Fax:
Practice Address - Street 1:439 ROSEMONT ST
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-6061
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty