Provider Demographics
NPI:1720403876
Name:QUESADA, JULIO
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:
Last Name:QUESADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12035 5TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98168-2044
Mailing Address - Country:US
Mailing Address - Phone:206-696-3144
Mailing Address - Fax:
Practice Address - Street 1:12035 5TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98168-2044
Practice Address - Country:US
Practice Address - Phone:206-696-3144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175L00000X, 173C00000X
CTND100203171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175L00000XOther Service ProvidersHomeopath
No173C00000XOther Service ProvidersReflexologist