Provider Demographics
NPI:1972810216
Name:DAHLQUIST, CECILE (FNP)
Entity type:Individual
Prefix:
First Name:CECILE
Middle Name:
Last Name:DAHLQUIST
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5639
Mailing Address - Street 2:
Mailing Address - City:BLUE JAY
Mailing Address - State:CA
Mailing Address - Zip Code:92317-5639
Mailing Address - Country:US
Mailing Address - Phone:909-337-8865
Mailing Address - Fax:909-337-3717
Practice Address - Street 1:5500 UNIVERSITY PKWY
Practice Address - Street 2:CSUSB STUDENT HEALTH CENTER
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-2318
Practice Address - Country:US
Practice Address - Phone:909-537-5241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN389405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily