1609051192 NPI number — MS. CARMEN ALICIA QUERAL P.A.-C.

Table of content: MS. CARMEN ALICIA QUERAL P.A.-C. (NPI 1609051192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609051192 NPI number — MS. CARMEN ALICIA QUERAL P.A.-C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUERAL
Provider First Name:
CARMEN
Provider Middle Name:
ALICIA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C.
Provider Gender Code:
F

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:
1609051192
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7225 CRESCENT PARK W
Provider Second Line Business Mailing Address:
APT 239
Provider Business Mailing Address City Name:
PLAYA VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90094-2724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-510-4425
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11301 WILSHIRE BLVD.
Provider Second Line Business Practice Location Address:
DEPT. OF VA--GREATER LOS ANGELES HEALTHCARE SYSTEM
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-478-3711
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/03/2008

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: 363AM0700X , with the licence number:  PA 11484 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AM0700X , with the licence number: PA 910903 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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