Provider Demographics
NPI:1043697881
Name:QUANTUM HEALING MEDICAL CENTER INC
Entity type:Organization
Organization Name:QUANTUM HEALING MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:424-302-0261
Mailing Address - Street 1:1010 S ROBERTSON BLVD
Mailing Address - Street 2:A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1527
Mailing Address - Country:US
Mailing Address - Phone:424-302-0261
Mailing Address - Fax:424-302-0745
Practice Address - Street 1:1010 S ROBERTSON BLVD
Practice Address - Street 2:A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1527
Practice Address - Country:US
Practice Address - Phone:424-302-0261
Practice Address - Fax:424-302-0745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24259208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA24259Medicare Oscar/Certification