Provider Demographics
NPI:1134931447
Name:QUEVEDO, VANISHA NOAMI
Entity type:Individual
Prefix:MS
First Name:VANISHA
Middle Name:NOAMI
Last Name:QUEVEDO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:VANISHA
Other - Middle Name:NOAMI
Other - Last Name:QUEVEDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1106 BURGER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-2903
Mailing Address - Country:US
Mailing Address - Phone:323-236-9636
Mailing Address - Fax:
Practice Address - Street 1:21505 NORWALK BLVD
Practice Address - Street 2:
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716-1121
Practice Address - Country:US
Practice Address - Phone:562-916-7581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)