Provider Demographics
NPI:1407038037
Name:QUEVEDO, FEDERICO G (MD)
Entity Type:Individual
Prefix:
First Name:FEDERICO
Middle Name:G
Last Name:QUEVEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FREDERIC
Other - Middle Name:G
Other - Last Name:QUEVEDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:14340 CHANDLER BLVD
Mailing Address - Street 2:#204
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-5520
Mailing Address - Country:US
Mailing Address - Phone:818-995-3674
Mailing Address - Fax:
Practice Address - Street 1:14340 CHANDLER BLVD
Practice Address - Street 2:#204
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91401-5520
Practice Address - Country:US
Practice Address - Phone:818-995-3674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 23416207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology