Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CPO03733 | AZ |
NPI | 1063020972 |
---|---|
Provider Name | Kaitlin Quan |
First Address | Phoenix, AZ 85014-3639 |
Second Address | Phoenix, AZ 85014-3639 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2020 |
Last Update Date | 16/07/2020 |