Quincy Jade Cornell

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95023914 Issued in CA

Practice address

1225 W 190TH Street Suite 280
Gardena, CA 90248-2820

Phone

(877) 515-8113

Fax

(877) 538-2102

NPI assigned

Jun 23, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dadoyan Behavioral Medical Group Inc

  • Psychiatry Physician
  • Sherman Oaks, CA
  • NPI 1841687878
  Medicare reassignment

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

{
    "created_epoch": "1687478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693785600000",
    "number": "1457037558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "663 CAMBRIDGE ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941341637",
            "telephone_number": "415-203-6169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 W 190TH STREET SUITE 280",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902482820",
            "telephone_number": "877-515-8113",
            "fax_number": "877-538-2102"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14541 Delano St",
            "address_purpose": "LOCATION",
            "city": "Van Nuys",
            "state": "CA",
            "postal_code": "914112820",
            "country_code": "US",
            "telephone_number": "877-515-8113",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CORNELL",
        "first_name": "QUINCY",
        "middle_name": "JADE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-06-23",
        "last_updated": "2023-09-04",
        "certification_date": "2023-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95023914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raven Bilan Copeland, M.D.
• Sherley Cordova
• Victoria Guadalupe Cordova
• Genesis Core
• Jimena Cornelio
• Savannah Denise Corniel
• Maria Beatriz Corona
• Litzy Coronado
• Annette A Coronel Perey, MD
• Brandon Corral

• Psychiatric/Mental Health Nurse Practitioner in Gardena, CA
• Providers in Gardena, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.