Provider Demographics
NPI:1154808277
Name:QUARTARO, LAUREL JANENE (RDA)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:JANENE
Last Name:QUARTARO
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30035 HAUN RD
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-6805
Mailing Address - Country:US
Mailing Address - Phone:951-225-3324
Mailing Address - Fax:
Practice Address - Street 1:30035 HAUN RD
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-6805
Practice Address - Country:US
Practice Address - Phone:951-225-3324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-21
Last Update Date:2018-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22755126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22755Medicaid