Provider Demographics
NPI:1386354447
Name:QUADRANT CA VIRTUAL PEDIATRIC MEDICAL CARE PC
Entity type:Organization
Organization Name:QUADRANT CA VIRTUAL PEDIATRIC MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE SHAREHOLDER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-520-8485
Mailing Address - Street 1:PO BOX 34464
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-0622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 W TOWN AND COUNTRY RD STE 1250
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4633
Practice Address - Country:US
Practice Address - Phone:866-219-8595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-30
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty