Provider Demographics
NPI:1295723567
Name:QUILICI, PHILIPPE JEAN (MD, FACS)
Entity type:Individual
Prefix:DR
First Name:PHILIPPE
Middle Name:JEAN
Last Name:QUILICI
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S BUENA VISTA ST
Mailing Address - Street 2:SUITE 425
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4569
Mailing Address - Country:US
Mailing Address - Phone:818-848-8311
Mailing Address - Fax:818-953-9366
Practice Address - Street 1:201 S BUENA VISTA ST
Practice Address - Street 2:SUITE 425
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4569
Practice Address - Country:US
Practice Address - Phone:818-848-8311
Practice Address - Fax:818-953-9366
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40945174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A40950OtherMEDICAL
CAA40945Medicare ID - Type Unspecified
CA00A40950OtherMEDICAL