Provider Demographics
NPI:1356911200
Name:QUACH, MINH (MD)
Entity type:Individual
Prefix:DR
First Name:MINH
Middle Name:
Last Name:QUACH
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 1:2450 S TELSHOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-5069
Mailing Address - Country:US
Mailing Address - Phone:575-521-5370
Mailing Address - Fax:
Practice Address - Street 1:555 E TACHEVAH DR STE 2E107
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5752
Practice Address - Country:US
Practice Address - Phone:760-561-7373
Practice Address - Fax:760-327-5140
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRS2021-0706390200000X
CAA194193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program