Eastfield Ming Quong

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

20903 Issued in CA

Legal business name

EASTFIELD MING QUONG

Practice address

209 Lemos Ave
Santa Cruz, CA 95060-5114

Phone

(831) 421-9918

NPI assigned

Nov 28, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Kelli Williamson, PSYD

Title

Clinical Program Manager

Phone

(408) 832-0832

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093881112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 LEMOS AVE",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950605114",
            "telephone_number": "831-421-9918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 LEMOS AVE",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950605114",
            "telephone_number": "831-421-9918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTFIELD MING QUONG",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILLIAMSON",
        "authorized_official_first_name": "KELLI",
        "authorized_official_title_or_position": "CLINICAL PROGRAM MANAGER",
        "authorized_official_telephone_number": "408-832-0832",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CA",
            "license": "20903",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVER'S LICENSE",
            "identifier": "A5480825",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rowan Duran Knoff
• Sonia Marina Duran, LCSW
• Michael Louis Dworkin, MD
• Leo Anthony Dyble
• Kenzie Earle
• Diana Marcela Eaton, MEDICAL ASSISTANT
• Jeffrey Lee Ebbage
• William Ebert, MD
• Morvarid Ebrahimi, M.D.
• Mark Ebrahimian, D.M.D.

• Community/Behavioral Health Agency in Santa Cruz, CA
• Providers in Santa Cruz, CA by specialty
• Community/Behavioral Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.