Provider Demographics
NPI:1669663001
Name:REZA, JAIME QUEZADA (BA)
Entity Type:Individual
Prefix:MR
First Name:JAIME
Middle Name:QUEZADA
Last Name:REZA
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:23834 BRITTLEBUSH CIR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-2932
Mailing Address - Country:US
Mailing Address - Phone:951-242-0262
Mailing Address - Fax:951-443-2230
Practice Address - Street 1:1688 N PERRIS BLVD
Practice Address - Street 2:SUITE L7-11
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-4709
Practice Address - Country:US
Practice Address - Phone:951-443-2200
Practice Address - Fax:951-443-2230
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health