Provider Demographics
NPI:1548391907
Name:QUEVEDO, JESSICA PILAR (PSYD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:PILAR
Last Name:QUEVEDO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 E 120TH ST
Mailing Address - Street 2:TRAILER 6
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-3051
Mailing Address - Country:US
Mailing Address - Phone:310-668-8311
Mailing Address - Fax:310-668-3458
Practice Address - Street 1:1721 E 120TH ST
Practice Address - Street 2:TRAILER 6
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-3051
Practice Address - Country:US
Practice Address - Phone:310-668-8311
Practice Address - Fax:310-668-3458
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPS-2007020103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical