Provider Information for 1336614940
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KARISA NICOLE QUICK
Sex: Female
NPI: 1336614940
Last Updated: 2018-10-10
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1336614940 | ||||||||
| Enumeration Date | 2018-10-10 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 5083 COLUMBIA DR FONTANA, CA 92336-0617 United States Phone: 760-508-1320 | Fax: | ||||||||
| Primary Practice Address | 231 N EUCLID AVE UPLAND, CA 91786-6038 United States Phone: 909-815-9841 | Fax: | ||||||||
| Secondary Practice Address(es) | 5083 COLUMBIA DRIVE | ||||||||
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