Provider Demographics
NPI:1417447798
Name:QUEZON, IRVIN JUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:IRVIN
Middle Name:JUSTIN
Last Name:QUEZON
Suffix:
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 1:2900 N BRAESWOOD BLVD APT 3123
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-2360
Mailing Address - Country:US
Mailing Address - Phone:858-349-3574
Mailing Address - Fax:
Practice Address - Street 1:18839 MCKAY DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5721
Practice Address - Country:US
Practice Address - Phone:281-446-3655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-13
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR77019208600000X
390200000X
TXT8919208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program