Individual
QUINCY JADE CORNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1225 W 190TH STREET SUITE 280, GARDENA, CA 90248-2820
(877) 515-8113
(877) 538-2102
Mailing address
663 CAMBRIDGE ST, SAN FRANCISCO, CA 94134-1637
(415) 203-6169
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95023914
CA
Other
Enumeration date
06/23/2023
Last updated
09/04/2023
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