Provider Demographics
NPI:1205831799
Name:DEQUIROZ, PAULINA M (MD)
Entity type:Individual
Prefix:DR
First Name:PAULINA
Middle Name:M
Last Name:DEQUIROZ
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 1:1665 SCENIC AVE.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2925 N. PALO VERDE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815
Practice Address - Country:US
Practice Address - Phone:714-442-4864
Practice Address - Fax:714-442-4892
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29803208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A298030OtherMEDI CAL
CA00A298030OtherMEDI CAL