Provider Demographics
NPI:1629507348
Name:QUINN, ALEXIA FUERTES (MA, JD)
Entity Type:Individual
Prefix:
First Name:ALEXIA
Middle Name:FUERTES
Last Name:QUINN
Suffix:
Gender:F
Credentials:MA, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 FREMONT PL
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-4449
Mailing Address - Country:US
Mailing Address - Phone:805-280-6520
Mailing Address - Fax:
Practice Address - Street 1:633 FREMONT PL
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-4449
Practice Address - Country:US
Practice Address - Phone:805-280-6520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80829106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist