1922207463 NPI number — TQ PEDIATRICS, INC.

Table of content: DR. JOSE JOAQUIN GONZALEZ PH.D. (NPI 1538244538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922207463 NPI number — TQ PEDIATRICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TQ PEDIATRICS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922207463
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11704
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92685-1704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10900 WARNER AVE
Provider Second Line Business Practice Location Address:
SUITE 118
Provider Business Practice Location Address City Name:
FOUNTAIN VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92708-3846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-968-7938
Provider Business Practice Location Address Fax Number:
714-968-7990
Provider Enumeration Date:
07/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
THANH
Authorized Official Middle Name:
QUOC
Authorized Official Title or Position:
C.E.O.
Authorized Official Telephone Number:
714-968-7938

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  A92305 , 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: 00A923050 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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