Provider Demographics
NPI:1376118760
Name:QUEZADA, LUZ ELENA
Entity Type:Individual
Prefix:MS
First Name:LUZ
Middle Name:ELENA
Last Name:QUEZADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19220 CHESHIRE ST
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92377-4538
Mailing Address - Country:US
Mailing Address - Phone:714-815-4942
Mailing Address - Fax:
Practice Address - Street 1:19220 CHESHIRE ST
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92377-4538
Practice Address - Country:US
Practice Address - Phone:714-815-4942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered