Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 20A13609 | CA |
N | 2084N0600X | Clinical Neurophysiologist | 20A13609 | CA |
NPI | 1619288172 |
---|---|
Provider Name | Tara Ann Quesnell |
First Address | Carlsbad, CA 92011-4219 |
Second Address | Carlsbad, CA 92011-4219 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2010 |
Last Update Date | 18/03/2020 |