Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | A24556 | CA |
NPI | 1700915311 |
---|---|
Provider Name | Dr. Jorge Antonio Quel |
First Address | Marina Del Rey, CA 90292-6390 |
Second Address | Marina Del Rey, CA 90292-6390 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A24556 | MEDICAL LICENSURE (01) | CA |
A83043 | (02) | CA |