Provider Demographics
NPI:1376176206
Name:FLORES-QUEZADA, ROGELIA
Entity Type:Individual
Prefix:
First Name:ROGELIA
Middle Name:
Last Name:FLORES-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 1:4444 PARKS AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-6188
Mailing Address - Country:US
Mailing Address - Phone:619-248-1685
Mailing Address - Fax:
Practice Address - Street 1:4444 PARKS AVE APT 8
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-6188
Practice Address - Country:US
Practice Address - Phone:619-248-1685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA4311991OtherDRIVER LICENSE