Provider Demographics
NPI:1871761205
Name:QUARLES, TODD WAYNE (LAC)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:WAYNE
Last Name:QUARLES
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 A AVE
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-3318
Mailing Address - Country:US
Mailing Address - Phone:619-889-1753
Mailing Address - Fax:
Practice Address - Street 1:910 A AVE
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-3318
Practice Address - Country:US
Practice Address - Phone:619-889-1753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9551171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist