Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY5319 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY5319 | CA |
NPI | 1003039314 |
---|---|
Provider Name | Dr. Quin Linus Crosbie |
First Address | Santa Monica, CA 90405-5925 |
Second Address | Santa Monica, CA 90405-3221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00PL53190 | BLUE SHIELD (01) | CA |
PSY5319 | BLUE CROSS (01) | CA |