Provider Demographics
NPI:1427499748
Name:QSA GROUP,LLC
Entity type:Organization
Organization Name:QSA GROUP,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAZEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-306-5115
Mailing Address - Street 1:29 PRAIRIE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-8840
Mailing Address - Country:US
Mailing Address - Phone:949-306-5115
Mailing Address - Fax:949-825-5189
Practice Address - Street 1:29 PRAIRIE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-8840
Practice Address - Country:US
Practice Address - Phone:949-306-5115
Practice Address - Fax:949-825-5189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46078208M00000X
CAA105921208M00000X
CAA110080208M00000X
CAA125541208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty