Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | A151988 | CA |
NPI | 1003239948 |
---|---|
Provider Name | Mr. Jesse Qualliotine |
First Address | San Diego, CA 92103-1911 |
Second Address | San Diego, CA 92103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2014 |
Last Update Date | 19/02/2019 |