Individual
MICHAEL QUICENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
81800 DOCTOR CARREON BLVD STE B, INDIO, CA 92201-5595
(760) 647-7676
(760) 347-0909
Mailing address
81800 DOCTOR CARREON BLVD STE B, INDIO, CA 92201-5595
(760) 647-7676
(760) 347-0909
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
95011137
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95011137
CA
Other
Enumeration date
02/25/2019
Last updated
03/04/2026
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