Provider Demographics
NPI:1326442138
Name:QUEJADO, URSULA ROSIE (CNA)
Entity Type:Individual
Prefix:
First Name:URSULA ROSIE
Middle Name:
Last Name:QUEJADO
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 TABOC
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:LA UNION
Mailing Address - Zip Code:2514
Mailing Address - Country:PH
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3801 MIRANDA AVE.
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94504
Practice Address - Country:US
Practice Address - Phone:650-694-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00583893376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide