1699907709 NPI number — DR. ALYSSA MAE QUIMBY M.D.

Table of content: DR. ALYSSA MAE QUIMBY M.D. (NPI 1699907709)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699907709 NPI number — DR. ALYSSA MAE QUIMBY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUIMBY
Provider First Name:
ALYSSA
Provider Middle Name:
MAE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WITTENBERG
Provider Other First Name:
ALYSSA
Provider Other Middle Name:
MAE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699907709
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 31309
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90031-0309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-241-7250
Provider Business Mailing Address Fax Number:
213-241-7252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1127 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
SUITE 800
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90017-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-241-7250
Provider Business Practice Location Address Fax Number:
213-241-7252
Provider Enumeration Date:
08/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  A109861 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A109891 . This is a "CA MEDICAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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