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Organization
QUANTOM-LEAP, INC.
Active
Organization
QUANTOM-LEAP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARMEN MARONEY (ADMINISTRATOR)
(559) 244-1789
Entity
Organization
Contact information
Practice address
22368 SOUTH 6TH STREET, DOS PALOS, CA 93665
(559) 244-1789
Mailing address
7299 N CHANNING WAY, FRESNO, CA 93711-0487
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24004AP
MEDI-CAL PROVIDER NUMBER
CA
Enumeration date
11/09/2006
Last updated
08/22/2020
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