Provider Demographics
NPI:1700653334
Name:QUESADA, CHARLOTTE RILLERA (ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:RILLERA
Last Name:QUESADA
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 WINDRIFT WAY APT 155
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-5211
Mailing Address - Country:US
Mailing Address - Phone:480-584-8007
Mailing Address - Fax:
Practice Address - Street 1:3520 WINDRIFT WAY APT 155
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-5211
Practice Address - Country:US
Practice Address - Phone:480-584-8007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028220363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care