Provider Demographics
NPI:1750345401
Name:QUIET, CORAL A (MD)
Entity type:Individual
Prefix:
First Name:CORAL
Middle Name:A
Last Name:QUIET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9055 E DEL CAMINO DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-2363
Mailing Address - Country:US
Mailing Address - Phone:480-922-4600
Mailing Address - Fax:623-223-1196
Practice Address - Street 1:19646 N 27TH AVE STE 108
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4025
Practice Address - Country:US
Practice Address - Phone:480-922-4600
Practice Address - Fax:623-223-1196
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ216062085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ138075Medicaid
AZ138075OtherAHCCCS
AZZ30WCHJD13Medicare PIN
AZZ127575Medicare PIN
AZ138075OtherAHCCCS
AZE97392Medicare UPIN