Provider Demographics
NPI:1477641033
Name:QUEZADA, REBECA LETICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECA
Middle Name:LETICIA
Last Name:QUEZADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3270 KERNER BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-4840
Mailing Address - Country:US
Mailing Address - Phone:415-473-2100
Mailing Address - Fax:415-473-3850
Practice Address - Street 1:3270 KERNER BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-4840
Practice Address - Country:US
Practice Address - Phone:415-473-2100
Practice Address - Fax:415-473-3850
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA800652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACI4902OtherPTAN