Provider Demographics
NPI:1003018086
Name:QUESADA, MARIO JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:JOSEPH
Last Name:QUESADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203E ALTON GLOOR BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3831
Mailing Address - Country:US
Mailing Address - Phone:956-544-2663
Mailing Address - Fax:956-542-2366
Practice Address - Street 1:1201 E ALTON GLOOR BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-3831
Practice Address - Country:US
Practice Address - Phone:956-544-2663
Practice Address - Fax:956-542-2366
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13888207XS0114X
LAMD200497207XP3100X
TXQ1711207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1237710Medicaid