Basic Information
| Provider Information | |||||||||
| NPI: | 1164702486 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUIBILAN | ||||||||
| FirstName: | KHRISTINE | ||||||||
| MiddleName: | JAMORALIN | ||||||||
| NamePrefix: | MS. | ||||||||
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| OtherLastName: | QUIBILAN | ||||||||
| OtherFirstName: | KHRISTIN | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MS. | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 175 W SAINT JAMES ST | ||||||||
| Address2: | UNIT 708 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951102407 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 333 GELLERT BLVD | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | DALY CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940152621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6507550858 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2011 | ||||||||
| LastUpdateDate: | 08/17/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.