Provider Demographics
NPI:1093739252
Name:QUESADA, RAMON SERAPIO JR (MD)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:SERAPIO
Last Name:QUESADA
Suffix:JR
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 1:804 CORRIENTE POINT DR
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94065-1285
Mailing Address - Country:US
Mailing Address - Phone:650-587-0831
Mailing Address - Fax:
Practice Address - Street 1:804 CORRIENTE POINT DR
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94065-1285
Practice Address - Country:US
Practice Address - Phone:650-587-0831
Practice Address - Fax:818-898-4451
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA0251362085R0202X
CAA251362085B0100X, 2085D0003X, 2085U0001X, 2085N0904X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA24296Medicare UPIN