Provider Demographics
NPI:1003137027
Name:QUEZADA, EVELYN PATRICIA (BA)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:PATRICIA
Last Name:QUEZADA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1812 E DE LA GARZA LOOP APT C
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-5427
Mailing Address - Country:US
Mailing Address - Phone:928-750-7259
Mailing Address - Fax:
Practice Address - Street 1:2180 S 4TH AVE
Practice Address - Street 2:SUITE H
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6402
Practice Address - Country:US
Practice Address - Phone:928-750-7259
Practice Address - Fax:928-783-4081
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health