Provider Demographics
NPI:1073829099
Name:QUEZADA-ROSAS, JUANITA LETICIA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:LETICIA
Last Name:QUEZADA-ROSAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 PARDES LN RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-1609
Mailing Address - Country:US
Mailing Address - Phone:956-574-9710
Mailing Address - Fax:956-574-0442
Practice Address - Street 1:2155 PAREDES
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526
Practice Address - Country:US
Practice Address - Phone:956-574-9710
Practice Address - Fax:956-574-9715
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1770692196Medicaid