Provider Demographics
NPI:1477098184
Name:QUEZADA, EMILY (BA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:QUEZADA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17062 JURASSIC PL
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-7711
Mailing Address - Country:US
Mailing Address - Phone:909-904-2070
Mailing Address - Fax:
Practice Address - Street 1:17062 JURASSIC PL
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-7711
Practice Address - Country:US
Practice Address - Phone:909-904-2070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician