Provider Demographics
NPI:1790241503
Name:QUEZON, ADAM BALDUEZA (PTA)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:BALDUEZA
Last Name:QUEZON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 26TH AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-1739
Mailing Address - Country:US
Mailing Address - Phone:805-415-4635
Mailing Address - Fax:
Practice Address - Street 1:110 41ST ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5250
Practice Address - Country:US
Practice Address - Phone:510-596-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-17
Last Update Date:2019-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTA49079225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant