Provider Demographics
NPI:1841200482
Name:QUILALANG, SUSAN DE JESUS (NP RN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:DE JESUS
Last Name:QUILALANG
Suffix:
Gender:F
Credentials:NP RN
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1601 PRECISION PARK LN
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-1345
Mailing Address - Country:US
Mailing Address - Phone:619-662-4100
Mailing Address - Fax:619-428-2625
Practice Address - Street 1:1637 3RD AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910
Practice Address - Country:US
Practice Address - Phone:619-205-1360
Practice Address - Fax:619-205-1376
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA3714880163W00000X
CA5579363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FHC11992HOtherMEDI-CAL
W5740CMedicare ID - Type Unspecified