Provider Demographics
NPI:1699907709
Name:QUIMBY, ALYSSA MAE (MD)
Entity type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:MAE
Last Name:QUIMBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALYSSA
Other - Middle Name:MAE
Other - Last Name:WITTENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:213-241-7250
Mailing Address - Fax:213-241-7252
Practice Address - Street 1:1127 WILSHIRE BLVD
Practice Address - Street 2:SUITE 800
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3901
Practice Address - Country:US
Practice Address - Phone:213-241-7250
Practice Address - Fax:213-241-7252
Is Sole Proprietor?:No
Enumeration Date:2009-08-23
Last Update Date:2017-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109861207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA109891OtherCA MEDICAL LICENSE